Symptom scores of patients with chronic obstructive pulmonary disease and their response to different inhalation drug treatments / 中国医师杂志

Objective:To analyze the response of patients with chronic obstructive pulmonary disease (COPD) with multiple and few symptoms to different inhalation drugs, including acute exacerbation and symptom changes.Methods:This study was a multi center, retrospective Cohort study. The subjects of this study were patients with chronic obstructive pulmonary disease in stable stage in 12 hospitals in Hunan and Guangxi from December 2016 to February 2022. Demographics data, lung function, Chronic Obstructive Pulmonary Disease Assessment test questionnaire (CAT) score, modified British Medical Research Council dyspnea questionnaire (mMRC) score and inhalation drug scheme of patients were collected. According to the CAT and mMRC scores, patients were divided into a multi symptom group (CAT≥10 points or mMRC≥2 points) or a few symptom group (CAT<10 points and mMRC<1 point); Subsequently, they were divided into four subgroups based on the inhalation drug regimen: long-acting anticholinergic drugs (LAMA) group, long-acting β2-receptor agonists (LABA)+ inhaled corticosteroids (ICS) group, LABA+ LAMA group, and LABA+ LAMA+ ICS group. All patients were followed up for 1 year, with minimum clinical improvement (MCID) defined as a decrease of ≥2 points in the patient′s CAT score at 6 months, and clinical symptom deterioration (CSD) defined as an increase of ≥2 points in the patient′s CAT score at 6 months.Results:A total of 929 patients with chronic obstructive pulmonary disease were included, including 719(77.4%) with multiple symptoms and 210(22.6%) with few symptoms. There was no statistically significant difference in MCID, CSD, acute exacerbation, hospitalization frequency, and mortality rate among subgroups of asymptomatic COPD patients treated with different inhalation drug regimens (all P>0.05). Among patients with multiple symptoms of chronic obstructive pulmonary disease, compared to those who use LAMA or LABA+ ICS, those who used LABA+ LAMA or LABA+ LAMA+ ICS were more likely to obtain MCID and had a more significant improvement in CAT scores, and the risk of acute exacerbation is lower (all P<0.05). Conclusions:Lesser symptomatic COPD patients should receive single drug LAMA as the initial inhalation treatment drug, while multi symptomatic COPD patients should receive LABA+ LAMA as the initial inhalation treatment drug.

Efficacy of atomization with budesonide, salbutamol, and acetylcysteine in the adjuvant treatment of bronchopneumonia in children / 中国基层医药

Objective:To investigate the efficacy of atomization with budesonide, salbutamol, and acetylcysteine in the adjuvant treatment of bronchopneumonia in children.Methods:Seventy-two children with bronchopneumonia admitted to Huaiyuan Jingtu Hospital from July 2021 to June 2022 were retrospectively included in this study. These children were divided into BS and BSY groups according to different treatment methods. Based on conventional treatment, the BS group was given atomization treatment with budesonide and salbutamol, and the BSY group was given atomization treatment with budesonide, salbutamol, and acetylcysteine. After two courses of treatment, clinical efficacy, duration to improvements in symptoms and signs, adverse drug reactions, and changes in serum C-reactive protein and procalcitonin levels after treatment relative to those before treatment were compared between the two groups. The optimal medication plan was investigated.Results:The total response rate in the BSY group was 91.67% (33 cases/36 cases), which was significantly higher than 72.22% (26/36) in the BS group ( χ2 = 4.59, P = 0.032). The incidence of adverse drug reactions in the BSY group was 11.11% (4/36), which was significantly lower than 19.44% (7/36) in the BS group ( χ2 = 0.96, P = 0.326). After treatment, the levels of C-reactive protein and procalcitonin in the BSY group were (5.86 ± 5.66) mg/L and (2.59 ± 0.74) μg/L, respectively, which were lower than (15.64 ± 5.85) mg/L and (4.71 ± 0.93) μg/L in the BS group ( t = 7.20, 10.70, both P < 0.001). The durations to the disappearance of symptoms and signs including fever, cough, lung rales, and X-ray lung shadow in the BSY group were significantly shorter compared with the BS group ( t = 11.85, 4.19, 2.72, 2.39, all P < 0.05). Conclusion:Atomization with budesonide, salbutamol, and acetylcysteine in combination for the adjuvant treatment of bronchopneumonia in children can quickly relieve the clinical symptoms of children, improve the lung signs, reduce the degree of inflammation, and has a remarkable therapeutic effect on bronchopneumonia in children.

Effects of acupoint application therapy with Chinese medicine combined with tiotropium bromide inhalation on quality of life in patients with stable chronic obstructive pulmonary disease / 中国基层医药

Objective:To investigate the effects of acupoint application therapy with Chinese medicine combined with tiotropium bromide inhalation on quality of life in patients with stable chronic obstructive pulmonary disease (COPD).Methods:A total of 109 patients with stable COPD admitted to People's Hospital of Gaomi from March 2019 to May 2020 were included in this study. They were randomly divided into a control group ( n = 54) and an observation group ( n = 55). Both groups were given tiotropium bromide powder inhalation and acupoint application therapy ( Dazhui, Shenque, Feishu, Pishu, Shenshu and Zusanli). Chinese medicine ointment was applied in the observation group, but not in the control group. All patients were treated for 6 consecutive months. Before and after treatment, pulmonary function indicators [forced expiratory volume in the first second (FEV 1), the percentage of expiratory volume in the first second (FEV 1%), forced vital capacity (FVC), FEV 1/FVC], modified Medical Research Council (mMRC) dyspnea scale score, and the Saint George's Respiratory Questionnaire (SGRQ) score were compared between the two groups before and after treatment to evaluate therapeutic efficacy and quality of life. Results:Before and after treatment, there were no significant differences in FEV 1, FEV 1% and FEV 1/FVC between the two groups (all P > 0.05). After treatment, mMRC score and SGRQ total score in the observation group were (1.91 ± 0.27) points and (38.54 ± 8.18) points, respectively, which were significantly lower than (2.43 ± 0.33) points and (43.12 ± 7.86) points in the control group ( t = 4.93, 4.47, both P < 0.05). The number of exacerbations and the number of hospitalizations were (0.42 ± 0.09) times/6 months and (0.27 ± 0.05) times/6 months in the observation group and they were (0.69 ± 0.17) times/6 months and (0.47 ± 0.13) times/6 months in the control group. There were significant differences in these indices between the two groups ( t = 3.90, 3.85, P < 0.05). Conclusion:Acupoint application therapy with Chinese medicine combined with tiotropium bromide inhalation has a good therapeutic effect on stable COPD. The combined therapy can reduce the number of acute attacks and improve patient's quality of life. This study is scientific and innovative.

Research progress of triple therapy in chronic obstructive pulmonary disease / 中国医师杂志

Chronic obstructive pulmonary disease (COPD) is a chronic airway disease, which is mainly characterized by persistent respiratory symptoms and irreversible airflow limitation, with high prevalence and high mortality. Exacerbations of COPD will lead to deterioration of lung function and disease progression, which is the focus of COPD management. Pharmacological therapy for COPD is used to improve symptoms, lung function and health status, prevent and treat exacerbation. Triple inhaled therapy for COPD includes long-acting muscarinic antagonist (LAMA), long-acting β 2-agonist (LABA) and inhaled corticosteroid (ICS). This article will review the research progress of triple inhaled therapy for COPD, and provide a reference for the clinical management of COPD.

Clinical characteristics and guideline compliance analysis of chronic obstructive pulmonary disease patients with initial triple therapy in real-life world / 中国医师杂志

Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.

Status and compliance with the guideline of inhaled corticosteroids use in patients with chronic obstructive pulmonary disease / 中国医师杂志

Objective:To understand the use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) in the real world and analyze its compliance with the guidelines.Methods:This study is a multicenter, cross-sectional study. 1 051 COPD patients who were treated in the Second Xiangya Hospital of Central South University, the First Affiliated Hospital of Shaoyang College and Zhuzhou Central Hospital from January 2020 to March 2022 were collected. The general information, drug use, types of exposure risk factors, acute exacerbation (AE) in the past year, the scores of the modified British Medical Research Council Dyspnea Questionnaire (mMRC), COPD Assessment Test (CAT), pulmonary function, blood routine of patients were collected. The status of ICS use in COPD patients, the clinical characteristics and guideline compliance of non-ICS users and ICS users were analyzed.Results:Among 1 051 patients with COPD, ICS was used in 490 cases (46.6%) and was not used in 561 cases (53.4%). ICS use was associated with relapse, frequent AE, severe AE, Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) grade 2 or above, GOLD D group, mMRC score, bronchial asthma, and blood eosinophils (EOS) (all P<0.05). Among 1 051 patients, 583(55.5%) were newly treated, 222(38.1%) were newly treated with ICS, and 361(61.9%) were not treated with ICS. ICS use in newly treated patients was associated with frequent AE, severe AE in the past year, GOLD grade 2 to 3, GOLD B and D group, mMRC score, bronchial asthma, and blood EOS (all P<0.05). Conclusions:Nearly half of patients with COPD are treated with ICS, and patients with ICS use had a higher risk of AE, more severe symptoms, higher blood EOS, and higher rates of asthma. However, there still exists the phenomenon of overuse of ICS.

Effects of nebulization with high-dose budesonide combined with ipratropium bromide on airway remodeling and mucus secretion in patients with AECOPD / 中国基层医药

Objective:To investigate the effects of nebulization with high-dose budesonide (BUD) combined with ipratropium bromide (IB) on airway remodeling and mucus secretion in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).Methods:Ninety patients with AECOPD who received treatment in Wenling Hospital of Traditional Chinese Medicine between January 2020 and June 2021 were included in this study. They were assigned to the conventional-dose group ( n = 45, odd number) and high-dose group ( n = 45, even number) according to the number of admission. In the conventional-dose group, nebulization with IB (0.5 mg administered within 20 minutes, three times daily) and BUD (2 mg administered within 20 minutes, twice daily) was performed. In the high-dose group, nebulization with IB (0.5 mg administered within 20 minutes, three times daily) and BUD (4 mg administered within 20 minutes, twice daily) was performed. After nebulization, a mouthwash was required in each group. After 7 days of treatment, clinical efficacy was compared between the two groups. Before and 7 days after treatment, airway remodeling level (matrix metalloproteinase-9 and interleukin-8), airway mucus secretion (mucin-5ac and neutrophil elastase) and the incidence of adverse reactions were compared between the two groups. Results:Total response rate in the high-dose group was significantly higher than that in the conventional-dose group [95.56% (43/45) vs. 82.22% (37/45), χ2 = 4.05, P < 0.05]. After 7 days of treatment, serum matrix metalloproteinase-9 and interleukin-8 levels in the high-dose group were (416.96 ± 30.96) μg/L and (6.33 ± 1.03) μg/L, respectively, which were significantly lower than those in the conventional-dose group [(452.25 ± 32.16) μg/L, (7.85 ± 1.24) μg/L, t = 5.30, 6.32, both P < 0.001)]. After 7 days of treatment, serum mucin-5ac and neutrophil elastase levels in the high-dose group were (1.33 ± 0.21) μg/L and (4.06 ± 1.03) μg/L, respectively, which were significantly lower than those in the conventional-dose group [(1.58 ± 0.23) μg/L, (5.11 ± 1.14) μg/L, t = 5.38, 4.58, both P < 0.001]. There was no significant difference in incidence of adverse reactions between high-dose and conventional-dose groups [8.89% (4/45) vs. 4.44% (2/45), χ2 = 0.71, P > 0.05). Conclusion:Nebulization with high-dose BUD combined with IB for treatment of AECOPD can improve airway remodeling, reduce airway mucus hypersecretion and has definite therapeutic effects. Findings from this study are of great innovation and science.

Clinical study of Guben-Tiaoping Decoction in improving the success rate of inhaled corticosteroid stepwise treatment in asthma / 国际中医中药杂志

Objective:To evaluate the effect of combined use of Guben-Tiaoping Decoction on the success rate of stepwise treatment and life quality of asthma patients. Methods:A total of 76 patients with asthma in remission stage who were using ICS were divided into treatment group (38 cases) and control group(38 cases) according to random number table. Both groups were treated with ICS reduction based on the 2017 Gina Protocol. The treatment group was treated with Guben-Tiaoping Decoction for 12 weeks. The number of patients who were able to successfully complete the stepwise treatment after the end of the trial was calculated, the relevant indexes of Asthma Control Test (ACT), TCM Syndrome score, St. George’s respiratory questionnaire (SGRQ) and lung function were collected before and after treatment. Result:After 12 weeks’ treatment, the success rate of stepwise was 89.5% (34/38) in the treatment group and 78.9% (30/38) in the control group ( χ2=14.862, P=0.001). Meanwhile, the ACT score of the treatment group were better than those in the control group (Daytime symptoms t=-3.860, P=0.001, Dyspnea t=-2.007, P=0.40, Night waking t=-2.732, P=0.009, Reliever needed for symptoms t=-2.262, P=0.031, Control situation t=-6.994, P=0.001, Total Score t=-9.562, P=0.001). The score of TCM Syndrome in the treatment group was significantly lower than that of the control group ( P=0.001); PEF in treatment group [(6.92 ± 1.71) L vs. (5.84 ± 1.22) L; t=-2.880, P=0.005] was significantly better than that of the control group. Conclusion:Guben-Tiaoping Decoction is helpful to improve the success rate of ICS stepwise treatment and the life quality of patients.

O uso do brinquedo terapêutico na administração por inalação em pré-escolares / Using therapeutic toy for administering by inhalation in pre-schools / El uso de juguete terapéutico para administración por inhalación en preescolares

Objetivo: comparar o comportamento de pré-escolares durante o uso de administração por inalação, antes e após sessão de Brinquedo Terapêutico. Método: estudo quase-experimental de abordagem quantitativa, com a técnica de observação antes e após a intervenção, realizado por meio de amostra intencional, recrutadas em uma Unidade de Pronto Atendimento no interior de Minas Gerais. Os dados foram analisados por estatística descritiva e inferencial, coletados entre os meses de novembro de 2017 a abril de 2018. Resultados: foram avaliados 25 comportamentos de 99 pré-escolares durante a administração por inalação. Após a sessão, 73,7% estavam com a postura e expressão facial relaxada, 76,8% estavam à vontade, 19,2% interromperam o procedimento e 38,4 % solicitaram a presença da mãe ou acompanhante. Conclusão: o uso do brinquedo, favoreceu maior aceitação e adaptação de pré-escolares submetidos à administração por inalação, evidenciado a importância em implementar essa estratégia em serviços de pronto atendimento pediátrico.

Objective: to compare the behavior of preschoolers during inhalation therapy, before and after a Therapeutic Play session. Method: quasi-experimental, quantitative study using pre- and post-intervention observation with an intentional sample recruited at an Emergency Care Unit in Minas Gerais. Data were collected from November 2017 to April 2018 and analyzed by descriptive and inferential statistics. Results: twenty-five behaviors of 99 preschoolers were evaluated during inhalation administration. After the session, 73.7% were relaxed in posture and facial expression, 76.8% were comfortable, 19.2% interrupted the procedure, and 38.4% requested the mother or companion to be present. Conclusion: the use of toys favored greater acceptance and adaptation by preschoolers undergoing inhalation therapy, evidencing the importance of implementing this strategy in pediatric emergency services.

Objetivo: comparar el comportamiento de los preescolares durante la terapia de inhalación, antes y después de una sesión de Juego Terapéutico. Método: estudio cuantitativo cuasi-experimental utilizando observación previa y posterior a la intervención con una muestra intencional reclutada en una Unidad de Atención de Emergencia en Minas Gerais. Los datos se recopilaron de noviembre de 2017 a abril de 2018 y se analizaron mediante estadísticas descriptivas e inferenciales. Resultados: se evaluaron veinticinco comportamientos de 99 niños en edad preescolar durante la administración por inhalación. Después de la sesión, el 73.7% se relajó en la postura y la expresión facial, el 76.8% se sintió cómodo, el 19.2% interrumpió el procedimiento y el 38.4% solicitó que la madre o la acompañante estuvieran presentes. Conclusión: el uso de juguetes favoreció una mayor aceptación y adaptación por parte de los preescolares sometidos a terapia de inhalación, lo que evidencia la importancia de implementar esta estrategia en los servicios de emergencia pediátricos.

Assessment of different techniques for the administration of inhaled salbutamol in children breathing spontaneously via tracheal tubes, supraglottic airway devices, and tracheostomies.

BACKGROUND: Perioperative respiratory adverse events account for a third of all perioperative cardiac arrests, with bronchospasm and laryngospasm being most common. Standard treatment for bronchospasm is administration of inhaled salbutamol, via pressurized metered dose inhaler. There is little evidence on the best method of attaching the pressurized metered dose inhaler to the artificial airway during general anesthesia. AIM: The aim of this study is to investigate the best method to deliver aerosolized salbutamol via pressurized metered dose inhaler to the lungs of an anesthetized child. METHODS: We measured salbutamol delivered by pressurized metered dose inhaler through different sized tracheal tubes, supraglottic airway devices, and tracheostomies in vitro for methods commonly employed for connecting the pressurized metered dose inhaler to the artificial airway. Breathing was simulated for patients weighing 3, 16, 50, and 75 kg. Pressurized metered dose inhaler actuation coincided with inspiration. RESULTS: A pressurized metered dose inhaler combined with an in-line non-valved or valved spacer, or the direct method, when delivered via tracheal tube, was linked with improved delivered dose of salbutamol, compared to all other methods for 3 or 50 kg simulated patients weights. The delivered dose when using a non-valved spacer was greater than all methods for 16 and 75 kg patient weights. A spacer improved delivery for the flexible supraglottic airway device type, and there was no difference with or without a spacer for remaining types. CONCLUSION: Via tracheal tube and non-valved spacer, the following doses should be delivered after single actuation of a 100 µg labeled-claim salbutamol dose: ~2 µg kg-1 per actuation to a 3 kg neonate, ~1 µg kg-1 per actuation to a 16 kg child, and ~ 0.5 µg kg-1 per actuation for a 50-75 kg child. The least effective methods were the syringe, and the uni- and bidirectional adaptor methods, which require replacement by the direct method if a spacer is unavailable.

Therapeutic effect of salmeterol-fluticasone aerosol on mild to moderate chronic obstructive pulmonary disease / 中国基层医药

Objective@#To analyze the clinical efficacy of salmeterol-fluticasone aerosol in the treatment of mild to moderate chronic obstructive pulmonary disease (COPD).@*Methods@#From February 2017 to February 2018, 68 patients with mild to moderate COPD treated in the General Hospital of Shanxi Tongmei Group were selected in the study.The patients were divided into control group (34 cases) and observation group (34 cases) by random number table method.The control group was treated with salbutamol aerosol inhalation, while the observation group was treated with salmeterol and fluticasone aerosol inhalation.Both two groups were treated for 12 weeks.The clinical efficacy, improvement of pulmonary function, 6-minute walking distance, oxygen saturation and heart rate were compared between the two groups.@*Results@#The total effective rate of the observation group was 97.06% (33/34), which was significantly higher than that of the control group [73.53%(25/34)] (χ2=7.503, P<0.05). Before treatment, FEV1%, FEV1/FVC (percentage of forced expiratory volume in 1 second forced vital capacity), FEV1 (1 second hard breathing volume), blood oxygen saturation, heart rate and 6 min walking distance had no statistically significant differences between the two groups (all P>0.05). After treatment, the FEV1, FEV1/FVC, FEV1% in the observation group were (65.48±4.06)%, (74.66±8.12)%, (1.99±0.55) L, respectively, which were significantly higher than those in the control group [(63.55±6.14)%, (70.85±7.56)%, (1.71±0.52)L] (t=2.321, 2.002, 2.157, all P<0.05). The oxygen saturation, heart rate and 6-minute walking distance in the observation group were (92.27±1.83)%, (80.55±4.08)times/min and (263.35±28.73)m, respectively, which in the control group were (88.52±2.06)%, (91.43±5.16)times/min and (231.95±22.69)m, respectively, and there were statistically significant differences between the two groups (t=7.936, 9.644, 5.001, all P<0.05).@*Conclusion@#Salmeterol and fluticasone aerosol inhalation has good clinical efficacy in the treatment of mild to moderate COPD, and can significantly improve the lung function of patients.

Analysis of the effect of oxygen driven aerosol inhalation in the treatment of acute exacerbation of bronchial asthma / 中国基层医药

Objective To analyze the effect of oxygen driven aerosol inhalation in the treatment of acute exacerbation of bronchial asthma .Methods 96 patients with acute exacerbation of bronchial asthmawere selected as the subjects .They were divided into observation group and control group by the random number table ,48 cases in each group.All patients were treated with salbutamol and budesonide inhalation therapy ,the control group was treated with ultrasonic atomization inhalation ,the observation group was treated with oxygen driven aerosol inhalation .The changes of blood oxygen saturation ( SpO2 ) ,maximum expiratory peak flow ( PEF) ,forced expiratory volume in the first second ( FEV1 ) and respiratory index ( RI) were observed before and after treatment in the two groups .The time of disappear-ance of major clinical symptoms was compared ,and the clinical treatment effect was analyzed .Results After treat-ment,the total effective rate of the observation group was 91.67％,which of the control group was 72.92％,the differ-ence between the two groups was statistically significant (χ2 =7.19,P<0.05).Compared with the control group ,the fever,cough,asthma,wheezing,shortness of breath,pulmonary rales and main clinical symptoms disappear time of the observation group were significantly shortened [observation group:(3.05 ±1.23)d,(4.43 ±1.16)d,(3.12 ± 1.11)d,(4.26 ±1.37)d,(4.98 ±1.75)d,(3.51 ±1.37)d;control group:(4.14 ±1.03)d,(7.75 ±1.98)d, (5.75 ±1.86)d,(6.53 ±1.46)d,(8.42 ±1.55)d,(6.53 ±1.46)d,t=4.71,10.02,8.41,7.86,10.20,10.45, all P<0.01].After treatment,the SpO2,PEF and FEV1 of the two groups were significantly increased [observation group:( 98.70 ±1.44 )％, ( 126.33 ±9.87 ) mL/min, ( 2.06 ±0.52 ) L;control group:( 83.15 ±1.39 )％,(108.32 ±7.26)mL/min,(1.42 ±0.38)L],while RI decreased significantly[observation group:(0.17 ±0.08), control group:(0.27 ±0.06),the differences were significant (to =36.18,16.77,12.04,10.69,tc =11.03,8.15, 5.34,2.69,all P<0.01),and the improvement of SpO2,PEF,FEV1 and RI of the observation group were significantly better than those of the control group (t=53.8310.18,6.88,6.74,all P<0.01).Conclusion In the treatment of acute exacerbation of bronchial asthma ,the clinical efficacy of oxygen driven aerosol inhalation is significant .The way can better alleviate patients'major clinical symptoms,such as fever,cough,improve lung ventilation function,and is worthy of further clinical application .

Avaliação de vídeos sobre a técnica inalatória na asma infantil: educativos ou midiáticos? / Assessment of videos about the inhalation technique for childhood asthma: educational or mediatic?

Vídeos relacionados à técnica inalatória na asma são populares no YouTube, mas sua qualidade é questão de preocupação. Neste estudo objetivou-se avaliar vídeos que demonstram a técnica inalatória do inalador pressurizado acoplado ao espaçador, para crianças e adolescentes com asma, quanto a conformidade das diretrizes da Global Initiative for Asthma. Estudo exploratório, realizado em 11 de julho de 2017 usando os termos inalador pressurizado e aerossol dosimetrado. Os vídeos foram avaliados por três enfermeiras, independentes e experientes na área, quanto aos critérios de conteúdo, produção e usuários. Dentre os 492 vídeos encontrados, seis preencheram os critérios de elegibilidade. Ponto de destaque foi a demonstração incorreta da técnica inalatória em todos os vídeos e a pontuação inadequada na avaliação técnica e de conteúdo. As descobertas deste estudo mostram que os vídeos não são confiáveis e nem compatíveis com as diretrizes de asma e, portanto, não podem ser recomendados para fins educacionais.

Videos related to asthma inhaling technique are popular on YouTube, but their quality is concerning. In this study, we aimed to assess videos demonstrating the inhaling technique of the pressurized metered dose inhaler, attached to the spacer, for children and adolescents with asthma, according to the guidelines of the Global Initiative for Asthma. We conducted an exploratory study, on 11 July 2017 using the terms "inalador pressurizado" and "aerossol dosimetrado". Three independent nurses experienced in the field assessed the videos regarding content inclusion, production, and users. Within the 492 videos found, six met the eligibility criteria. The highlight point was the incorrect demonstration of the inhalation technique in all videos and the inadequate scoring for technique and content assessments. Our study findings show that videos are not reliable neither compatible with asthma guidelines and, therefore, they should not be recommended for educational purposes.

Influence of inhaled budesonide and salbutamol on oxidative stress and serum inflammatory cytokines in children with bronchial asthma / 中国基层医药

Objective To observe the clinical effect of budesonide combined with salbutamol in the treatment of children with bronchial asthma,and its influence on oxidative stress and serum interleukin-2 (IL-2),soluble IL-2 receptor (sIL-2r) levels.Methods 70 children with bronchial asthma were divided into observation group and control group according to the different treatment,35 cases in each group.The observation group was inhaled budesonide combined with salbutamol,the control group was given salbutamol inhalation therapy.The clinical efficacy of the two groups was observed,and the changes of serum oxidative stress factor,IL-2 and sIL-2r levels before and after treatment in the two groups were compared.Results In the observation group,20 cases were cured,7 cases were markedly effective,effective in 5 cases,the total effective rate was 94.3％.In the control group,17 cases were cured,6 cases were markedly effective,effective in 4 cases,the total effective rate was 77.1％.The total effective rate between the two groups had statistically significant difference (x2 =26.543,P ＜ 0.05).After treatment,the malondialdehyde (MDA),end products (AOPP) of the observation group were (16.26 ± 1.76)U/L,(42.123 ± 5.745) μmol/L,respectively,which were lower than those of the control group [(22.16 ± 2.84) U/L,(63.63 ± 6.22) μ mol/L,t =23.354,25.348,all P ＜ 0.05].The glutathione peroxidase (GSH-PX),superoxide dismutase (SOD) of the observation group were (236.46 ± 32.25) ng/L,(19.643 ± 3.587) ng/L,respectively,which were higher than those of the control group [(197.43 ± 18.42) ng/L,(18.244 ± 2.446) ng/L,t =18.943,15.123,all P ＜O.05].The IL-2,sIL-2r levels of the observation group were (5.28 ± 2.65) μg/L,(30.376 ± 2.147) mg/L,respectively,which were significantly lower than those of the control group [(9.84 ± 3.22) μg/L,(37.564 ± 1.323)mg/L],the differences were statistically significant (t =21.378,24.643,all P ＜ O.05).Conclusion Inhaled budesonide combined with salbutamol in the treatment of children with bronchial asthma is helpful to control the symptoms of asthma,and can inhibit oxidative stress,reduce serum sIL-2r and IL-2 levels,it is worthy of promotion.

Impact of long-term treatment with inhaled corticosteroids and bronchodilators on lung function in a patient with post-infectious bronchiolitis obliterans / Impacto do tratamento de longo prazo com corticosteroides e broncodilatadores inalatórios na função pulmonar em um paciente com bronquiolite obliterante pós-infecciosa

ABSTRACT Post-infectious bronchiolitis obliterans (PIBO) is a small airways disease characterized by fixed airflow limitation. Therefore, inhaled bronchodilators and corticosteroids are not recommended as maintenance therapy options. The management of PIBO currently consists only of close monitoring of affected patients, aimed at the prevention and early treatment of pulmonary infections. In recent years, there has been an increase in the incidence of PIBO in the pediatric population. Patients with PIBO are characterized by a progressive decline in lung function, accompanied by a decrease in overall functional capacity. Here, we report the case of a relatively young man diagnosed with PIBO and followed for three years. After short- and long-term therapy with an inhaled corticosteroid/long-acting 2 agonist combination, together with an inhaled long-acting antimuscarinic, the patient showed relevant improvement of airway obstruction that had been irreversible at the time of the bronchodilator test. The lung function of the patient worsened when he interrupted the triple inhaled therapy. In addition, a 3-week pulmonary rehabilitation program markedly improved his physical performance.

RESUMO A bronquiolite obliterante pós-infecciosa (BOPI) é uma doença das pequenas vias aéreas caracterizada por limitação fixa do fluxo aéreo. Portanto, os broncodilatadores e os corticosteroides inalatórios não são recomendados como opções de terapia de manutenção. Atualmente, o manejo da BOPI consiste apenas de um acompanhamento rigoroso dos pacientes afetados, visando à prevenção e ao tratamento precoce de infecções pulmonares. A incidência de BOPI tem aumentado na população pediátrica nos últimos anos. Os pacientes com BOPI caracterizam-se por um declínio progressivo da função pulmonar, associado a uma diminuição da capacidade funcional global. Relatamos aqui o caso de um homem relativamente jovem diagnosticado com BOPI, acompanhado por três anos. Após terapia de curto e de longo prazo com uma combinação de corticosteroide/2-agonista de longa duração inalatórios, associada a um agente antimuscarínico de longa duração inalatório, o paciente apresentou uma melhora relevante da obstrução das vias aéreas, a qual fora irreversível durante o teste de broncodilatação. A função pulmonar do paciente piorou quando ele interrompeu a terapia inalatória tripla. Além disso, um programa de reabilitação pulmonar de três semanas significativamente melhorou seu desempenho físico.

Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients.

PURPOSE: Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice. METHODS: Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted. RESULTS: A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI95 22-26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (n = 262) received aerosols, and 50 % (n = 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (n = 7960) and corticosteroids (n = 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (<1 %) mild side effects were observed, despite frequent suboptimal set-ups such as an external gas supply of jet nebulizers for intubated patients. CONCLUSIONS: Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.

Clinical study on pulmonary complications after thoracotomy in elderly patients treated with atomization inhalation ofQingjin-Huatandecoction / 国际中医中药杂志

Objective The study was designed to investigate the effect of atomization inhalation of Qingjin-Huatandecoction on prevention of elderly patients’ postoperative pulmonary complications after thoracotomy.MethodsA total of 60 elderly patients with thoracotomy were randomized into 2 groups. Both groups of patients were treated with oxygen uptake, anti-infection, antispasmodic, analgesic, and nutritional support. Based on the conventional treatment, the control group was added with atomization inhalation of mucosolvan and dexamethasone, while the treatment group with atomization inhalation ofQingjin-Huatan decoction. The volume of phlegm, serum CRP, TNF-α level and absolute neutrophil count (ANC), arterial blood gasanalysis, and records of the pulmonary complications were meausred.Results The pH value at Day 3 (7.39 ± 0.06vs. 7.36 ± 0.05,t=2.120), the PaO2at Day 3 (86.51 ± 3.96 mmHgvs. 84.07 ± 3.51 mmHg,t=2.520) and Day 5 (92.27 ± 2.94 mmHgvs. 90.40 ± 3.08 mmHg,t=2.400) of treatment group were significantly higher than those of the control group; the PaCO2at Day 3 (44.57 ± 2.53 mmHgvs. 46.39 ± 3.35 mmHg,t=2.390) and  Day 5 (40.77 ± 2.48 mmHgvs. 42.42 ± 3.33 mmHg,t=2.130) of treatment group were significantly lower than those of the control group. The serum CRP at Day 3(8.26 ± 2.38 mg/Lvs. 9.76 ± 2.37 mg/L,t=2.440) and Day 5 (6.94 ± 1.76 mg/Lvs. 8.15 ± 2.38 mg/L,t=2.250), the ANC at Day 3 (8.54 ± 1.85)×109/Lvs. (9.58 ± 1.94)×109/L, t=2.140) and Day 5 (6.54 ± 1.85)×109/Lvs. (7.58 ± 1.95)×109/L,t=2.160), the serum TNF-a at Day 5 (7.54 ± 1.38 mg/Lvs. 8.43 ± 1.36 mg/L,t=2.540) of treatment group were significantly lower than those of the control group. The sputum volume at Day 3 (50.74 ± 18.46 ml/dvs. 59.92 ± 15.25 ml/d,t=2.099) and Day 5 (39.64 ± 18.21 ml/dvs. 48.99 ± 13.55 ml/d,t=2.256) of treatment group was lower than that of the control group. At Day 5, the pneumonia (3.33%vs. 20.00%,t=4.043) and the atelectasis (6.67%vs. 26.77%,t=4.320) of treatment group were significantly lower than those of the control group(P<0.05).ConclusionAtomization inhalation ofQingjin-Huatandecoction can improve pulmonary function of postoperative pulmonary complications of elderly patients after thoracotomy, take control of inflammation and the occurrence of postoperative pulmonary complications.

Clinical study on the treatment of allergic rhinitis by rhinitis desensitization prescription with nebulization suction / 中国基层医药

Objective To observe the clinical effect of rhinitis desensitization prescription with nebulization suction in the treatment of allergic rhinitis.Methods 100 patients of allergic rhinitis were randomly divided into control group(50 cases)and study group(50 cases).The control group was given conventional treatment,study group on the basis of conventional therapy was given rhinitis desensitization atomization inhalation.The clinical efficacy was compared between the two groups.Results After 1 course,three course,1 month of treatment,the total effective rates of the study group were 90%,92%,96%,which of the control group were 86%,88%,and 90% respectively,the differences between the two groups were statistically significant (χ2 =3.87,4.10,4.30,all P <0.05).Conclusion Rhinitis desensitization atomization inhalation in the treatment of allergic rhinitis has good curative effect,and it has high clinical application value.

Clinical curative effect of budesonide inhalation in the treatment of children with Pneumonia / 中国基层医药

Objective To investigate the clinical effect of budesonide inhalation in the treatment of children with pneumonia.Methods 100 children with pneumonia were randomly divided into the two groups.The control group received conventional oral medication,the observation group was given Pulmicort Turbuhaler (budesonide)inhalation therapy.The clinical efficacy and respiratory function changes were observed after treatment for 1 week.Results In the observation group,cough,shortness of breath,body temperature stable,pulmonary rales disappearance,X-ray absorption of inflammation and the average healing time were (1.28 ± 1.04) d,(2.48 ± 0.39) d,(2.04 ± 0.22) d,(2.22 ± 0.43) d,(3.39 ± 0.35) d,(3.65 ± 0.39) d,which were significantly better than those in the control group [(2.62 ± 1.63)d,(4.85 ± 1.38)d,(4.85 ± 1.31)d,(4.63 ±0.84)d,(5.53 ±0.82)d,(5.58 ±1.20) d(t =2.62,1.86,3.72,1.46,1.68,2.71,all P ＜0.05].In the observation group,the FEV1,PEF,FEF50％,FVC before treatment were (70.24 ± 10.46) L,(70.05 ± 12.86)L/s,(66.74 ± 11.77) ％,(67.16 ± 11.98) ％,after treatment were (90.14 ± 12.63) L,(92.64 ± 10.75) L/s,(84.56 ± 15.12) ％,(81.65 ± 13.96) ％,after treatment the indicators were significantly improved (t =2.34,4.83,1.89,3.27,all P ＜ 0.05).In the control group,before treatment,the FEV1,PEF,FEF50％,FVC were (70.56 ±9.95) L,(70.17 ± 13.58) L/s,(66.45 ± 11.58)％,(67.44 ± 12.37) ％,after treatment were (78.76 ± 11.44) L,(79.46 ± 14.36) L/s,(70.24 ± 12.39) ％,(72.03 ± 12.47) ％,after treatment all indicators were significantly improved (t =3.15,2.67,4.16,2.34,all P ＜ 0.05).The improvement of lung function in the observation group was significantly better than the control group (t =2.64,2.85,1.58,2.72,P ＜ 0.05).The effective rate of the observation group was 92％,which was significantly higher than 72％ of the control group (x2 =6.7 5 5,P ＜ 0.0 5).Conclusion Pulmicort Turbuhaler inhalation in the treatment of children with pneumonia can significantly relieve airway hyperresponsiveness,improve treatment effect,improve respiratory function.

Efficacy and safety of the single-capsule combination of fluticasone/formoterol in patients with persistent asthma: a non-inferiority trial / Eficácia e segurança da associação fluticasona/formoterol em cápsula única em pacientes com asma persistente: estudo de não inferioridade

OBJECTIVE: Fluticasone and formoterol are effective in the treatment of asthma. When a corticosteroid alone fails to control asthma, combination therapy is the treatment of choice. The objective of this study was to compare the efficacy and safety of formulations containing budesonide/formoterol (BUD/FOR), fluticasone alone (FLU), and the single-capsule combination of fluticasone/formoterol (FLU/FOR) on lung function in patients with mild-to-moderate persistent asthma. METHODS: This was a randomized, multicenter, open phase III trial conducted in Brazil. The primary efficacy analysis was the assessment of non-inferiority between FLU/FOR and BUD/FOR combinations regarding FEV1 (in L) at the final visit. The secondary analyses were PEF, level of asthma control, serum cortisol levels, frequency of adverse events, adherence to treatment, and appropriate inhaler use. RESULTS: We randomized 243 patients to three groups: FLU/FOR (n = 79), BUD/FOR (n = 83), and FLU (n = 81). In terms of the mean FEV1 after 12 weeks of treatment, the difference between the FLU/FOR and BUD/FOR groups was 0.22 L (95% CI: −0.06 to 0.49), whereas the difference between the FLU/FOR and FLU groups was 0.26 L (95% CI: −0.002 to 0.52). Non-inferiority was demonstrated by the difference between the lower limits of the two 95% CIs (−0.06 vs. −0.002). The level of asthma control and PEF were significantly greater in the FLU/FOR and BUD/FOR groups than in the FLU group. There were no significant differences among the groups regarding patient adherence, patient inhaler use, or safety profile of the formulations. CONCLUSIONS: The single-capsule combination of FLU/FOR showed non-inferiority to the BUD/FOR and FLU formulations regarding efficacy and ...

OBJETIVO: A fluticasona e o formoterol são efetivos no tratamento da asma. A terapia combinada é o tratamento de escolha quando o corticosteroide isolado não controla a asma. O objetivo deste estudo foi comparar a eficácia e segurança de formulações contendo budesonida/formoterol (BUD/FOR), fluticasona (FLU) e fluticasona/formoterol (FLU/FOR) em cápsula única sobre a função pulmonar em pacientes com asma persistente leve e moderada. MÉTODOS: Estudo de fase III multicêntrico brasileiro, aleatorizado e aberto. A análise primária de eficácia foi a avaliação de não inferioridade da combinação FLU/FOR perante a combinação BUD/FOR em relação ao VEF1 (em L) na visita final. As análises secundárias foram PFE, nível de controle da asma, nível de cortisol sérico, frequência de eventos adversos, aderência ao tratamento e uso adequado do inalador. RESULTADOS: Foram randomizados 243 pacientes nos grupos FLU/FOR (n = 79), BUD/FOR (n = 83) e FLU (n = 81). Após 12 semanas de tratamento, a média da diferença do VEF1 foi de 0,22 L (IC95%: −0,06 a 0,49) entre os grupos FLU/FOR e BUD/FOR e de 0,26 L (IC95%: −0,002 a 0,52) entre os grupos FLU/FOR e FLU. A não inferioridade ficou demonstrada pela diferença de limite inferior do IC95% (−0,06 vs. −0,002). O nível de controle da asma e o PFE foram significativamente maiores nos grupos FLU/FOR e BUD/FOR em comparação com o grupo FLU. Não houve diferenças significativas em relação a adesão, uso do inalador e perfil de segurança entre os grupos. CONCLUSÕES: ...