8省12市哮喘新知识调查问卷结果分析

目的调查国内儿科呼吸专业医师对全球哮喘防治战略(GINA)的了解及掌握程度.方法由首都儿科研究所哮喘防治与教育中心制订有关GINA方案的调查问卷,于1997～1998年在国内8个省份12个城市的哮喘培训班或讲座前向参加的专业医师共700人发放问卷.结果能正确选择哮喘的病理基础是气道慢性炎症者占56%～97.5%,选择中度以上哮喘的最重要治疗是吸入疗法者占28%～83.3%,对哮喘非重症急性发作时最佳的给药方式选择吸入者占64%～100%,能正确使用峰流速仪并记录曲线者占0～24.5%,已执行GINA方案者为0～36%.结论专业医师必须正确认识哮喘的新观念、吸入疗法及应用峰流速仪等作为哮喘病情及治疗监测指标等新方法,加强对GINA方案的推广应用.     

儿童难治性哮喘研究进展

随着气道炎症学说的公认和吸入激素的应用,特别是1994年全球哮喘防治创议 (GINA方案 )的制定和在全球的推广,儿童哮喘的治疗得以规范化和科学化,治疗效果也较以前有质的飞跃。尽管如此,临床上仍有约 5%的儿童哮喘应用目前推荐的规范治疗并不能使其症状缓解,这部分哮喘称为难治性哮喘。1　定义难治性哮喘目前尚无统一的定义,由于激素是目前控制哮喘的主要药物,所以多数研究组织 (如美国胸科协会和欧洲呼吸协会)在定义难治性哮喘时均以激素治疗反应作为主要指标,认为用常规治疗 (公认的GINA方案 )所推荐的吸入大剂量的糖皮质激素和短…     

哮喘知识教育和吸入激素对儿童哮喘的治疗作用

目的：探讨哮喘知识教育和吸入激素对儿童哮喘的作用。方法：将哮喘患儿分为规范治疗组和非规范治疗组(对照组),对规范治疗组进行哮喘知识教育,按GINA方案吸入激素治疗。对照组仅作发作时的处理,未进行系统教育及吸入激素,两组均记录病情变化、峰流速(PEF)、急诊次数。结果：经半年随访,规范治疗组总有效率 87.0%明显高于对照组 40.7%(P<0.05);规范治疗组PEF值为(251±44) L/min,明显高于对照组 (217±36)L/min(P<0.01);规范治疗组急诊就诊次数为(2.0±1.0)次,显著低于对照组(3.3±1.2)次(P<0.01)。结论：哮喘知识教育和吸入激素治疗有助于提高患儿的依从性,改善患儿的病情。     

氟替卡松联合沙丁氨醇吸入治疗儿童哮喘31例临床观察

全球哮喘防治创议的GINA方案中指出,防治哮喘的第一线药物最佳选择为吸入糖皮质激素(iGCS),唯有糖皮质激素能有效地抑制哮喘气道的炎症反应,β2受体兴奋剂能快速缓解症状。我们于2001年5月至2002年5月对门诊31例支气管哮喘患儿采用氟替卡松气雾剂(辅舒酮)联合沙丁氨醇(喘乐宁)溶液或/和气雾剂吸入治疗3个月,观察其临床症状的改善,用峰流速仪测定最大呼气流速(PEF),现总结如下。     

氟替卡松联合沙丁氨醇吸入治疗儿童哮喘31例临床观察

<正> 全球哮喘防治创议的GINA方案中指出,防治哮喘的第一线药物最佳选择为吸入糖皮质激素(iGCS),唯有糖皮质激素能有效地抑制哮喘气道的炎症反应,β2受体兴奋剂能快速缓解症状。我们于2001年5月至2002年5月对门诊31例支气管哮喘患儿采用氟替卡松气雾剂(辅舒酮)联合沙丁氨醇(喘乐宁)溶液或/和气雾剂吸入治疗3个月,观察其临床症状的改善,用峰流速仪测定最大呼气流速(PEF),现总结如下。     

基层医生GINA简易方案推广情况调查

目的了解基层医生对全球哮喘防治创议（GINA）方案落实情况。方法以问卷形式对参加“乡村医生培训班”的儿内科医生进行问卷调查。结果基层医生尚未全面了解GINA方案，特别对吸入激素存在一定的不足与误区，进修过的医生对GINA的了解明显高于未外出学习人员，存在明显差异（P〈0．01）。结论有必要进一步推广GINA方案在哮喘治疗与长期预防中的主导地位，强化基层医生对哮喘治疗的全面了解，定期举办“乡村医生培训班”等继续教育不失为一种行之有效的方法。     

基层医院儿童哮喘防治存在问题的调查及分析

目的　了解《全球哮喘防治的创议》简称GINA方案在基屋医院的执行情况。方法　抽检 2 0 0 1年 1月至 2 0 0 2年 9月在本院哮喘专科门诊登记或以哮喘住院的患儿 2 0 0例 ,通过问诊及查阅患儿在当地医院就诊病历 ,调查患儿既往在基层医院的诊治情况。结果　发现基层医院在儿童哮喘防治中尚存在着较多问题 :哮喘的诊断与鉴别诊断不清 ;哮喘的严重度分级有错误 ;哮喘急性发作期的治疗不当 ;部分医生及患儿家属对吸入激素有顾虑以及吸入装置使用不正确等几个方面。结论　执行GINA方案 ,进一步控制我国儿童哮喘 ,要重视基层医院临床医生诊治水平的提高。     

布地奈德雾化吸入联合中药内服防治儿童哮喘缓解期疗效观察

目的观察布地奈德雾化吸入联合中药内服防治儿童哮喘的疗效。方法将120例哮喘缓解期儿童随机分为联合组与西药组各60例。两组均常规健康宣传教育,布地奈德雾化吸入治疗,联合组同时加服补肾纳气散,疗程1年。测定肺活量(FVC)、第1秒用力呼气量(FEV1)、FEV1实际值占预计值百分比(FEV1%pred)、FEV1占用力肺活量百分比(FEV1/FVC)、呼气峰流速(PEF)、呼气峰流速百分比(PEF%)。结果治疗后两组FEV1、FEV1%pred、FEV1/FVC和PEF%均高于治疗前,差异有统计学意义(P<0.05);联合组治疗后FEV1、FEV1%pred、PEF%明显高于西药组,差异有统计学意义(P<0.05);治疗期间联合组和西药组急性发作分别是0.97人次和1.65人次,差异有统计学意义(P<0.05)。结论中西医结合防治儿童哮喘的效果优于单纯布地奈德治疗。     

哮喘相关因素调查分析

目的　了解小儿哮喘发病相关因素和防治状况 ,推广全球哮喘防治创议 (GINA)方案 ,规范化治疗儿童哮喘。方法　对在我院儿科哮喘门诊就诊或住院治疗并确诊为哮喘 116例患儿进行问卷调查及门诊随访观察。结果　 116例中以儿童哮喘为多占 80 .17% ,婴幼儿哮喘仅占 19.83% ,71.5 6 %首次喘息发生在 6岁以前。发病以春秋季节为多 ,尤以秋季最多占 31.0 3%。诱发因素以上呼吸道感染多见 ,其次为天气变化。一、二级亲属中有哮喘及其他过敏史分别为 5 .17%和 2 7.5 9% ,有婴幼儿湿疹、过敏性鼻炎等个人过敏史分别为30 .1%、5 8.6 2 %。 1年内诊断情况显示 ,误诊率为 18.10 %。4 4 .83%哮喘患儿能接受哮喘知识教育和规范化管理 ,坚持吸入激素治疗 ,其疗效明显优于非规范化治疗组 (P <0 .0 0 5 )。结论　哮喘发病与年龄、季节、诱因、家族史及个人过敏史等多种因素有关 ,及时诊断 ,规范化管理治疗十分重要     

《中国实用儿科杂志》2012哮喘患儿规范诊治病例征集比赛细则

目的:强调基于循证证据、哮喘指南(中国儿童哮喘诊治指南2008、GINA)推荐和哮喘控制评估,选择高效、安全的儿童哮喘首选药物,促进临床防治现状的改善应用哮喘控制测试量表C-ACT/ACT量表(年龄适宜者)准确评估哮喘的控制水平,强调基于哮喘控制评估制订儿童哮喘长期管理方案的必要性     

EVALUATION OF TWO SPIROMETERS AND TWO FLOWMETERS IN ASTHMATIC CHILDREN

ABSTRACT. The reliability of a Monaghan (M 403) spirometer and a Vitalograph spirometer was evaluated in 46 children with "subclinical" asthma. As in previous studies of healthy children the vital capacity (VC) and the forced expiratory volume in one second (FEV_1.0) were close to those of a Bernstein spirometer. The sensltivity of the spirometers and of two flowmeters (Wright's peak flow meter and Airflometer-Glaxo) was evaluated in the asthmatic children after inhalation of salbutamol and the changes after inhalation were compared to those obtained in a previous study of healthy children. The "simple" equipment gave substantial information about the degree of bronchial obstruction. It is concluded that the additional information obtained by using simple pulmonary function tests form a good basis for aggressive therapy.     

哮喘控制问卷在支气管哮喘患儿中的应用

目的对哮喘控制问卷(ACQ)和改良哮喘控制问卷(不计肺功能,简称ACQ6)在儿童哮喘控制评估中应用的可行性进行探讨。方法选取青岛大学医学院附属医院哮喘专家门诊确诊的哮喘患儿102例,进行肺功能测试,包括一秒钟用力呼气量占预计值百分比(FEV1%)和最大呼吸流量占预计值百分比(PEF%),并进行ACQ调查;同时根据2006《哮喘管理和预防的全球策略》的哮喘控制分级标准,对哮喘患儿进行病情界定并分为控制组、部分控制组及未控制组。对3组患儿ACQ和ACQ6得分进行比较;并以FEV1%和PEF%为分组依据,比较ACQ6得分在不同FEV1%、PEF%组间的差异,分析ACQ6得分与FEV1%和PEF%的趋同性和一致性;分别对ACQ得分、ACQ6得分、FEV1%、PEF%与专家哮喘控制评估结果进行相关性分析,以检验其相关密切程度。结果 3组哮喘患儿的ACQ和ACQ6得分比较差异有统计学意义(F=171.52、117.14,Pa<0.01);ACQ6得分在不同FEV1%、PEF%水平间差异均有统计学意义(F=69.53、76.20,Pa<0.01);ACQ6与FEV1%的Spearman相关系数为-0.818,与PEF%的Spearman相关系数为-0.862,ACQ6与PEF%的相关性较FEV1%的相关性高;ACQ得分、ACQ6得分、FEV1%及PEF%与专家评估结果的Spearman相关系数分别为0.931、0.915、-0.878和-0.882,与专家评估结果关系的密切相关程度从高到低依次为ACQ>ACQ6>PEF%>FEV1%。结论 ACQ和ACQ6对不同哮喘控制水平的患儿具有良好的鉴别能力。ACQ完全可应用于儿童哮喘控制水平的评估;在缺乏肺功能设备的基层医院,ACQ6值得推广应用。     

Inaccuracy of portable peak flow meters: correction is not needed

Abstract This study examined whether correction of peak expiratory flow (PEF) values for the inaccuracy of the meter would affect asthma management in 102 children (7–14 y old). PEF was recorded with a mini Wright meter twice daily for 2 weeks. As expected, measured PEF overestimated PEF level and asthma control in these children on many diary days. The actual numerical differences between measured and corrected PEF on these days were very small (>5% in only five patients, maximum 10%). It is unlikely that such small changes in PEF justify changes in asthma management, even if these changes cause PEF levels to cross arbitrary borders between various levels of asthma control used in self-management plans. The clinical importance of the inaccuracy of portable PEF meters is negligible.     

儿童β2-肾上腺素能受体基因多态性与哮喘及吸入治疗疗效的关系

目的探讨汉族儿童中β2-肾上腺素能受体(β2-AR)基因多态性对哮喘儿童发病和对长效β2受体激动剂(LABA)吸入疗效的影响。方法采用DNA直接测序法,分别检测212例哮喘儿童和52例健康体检儿童的β2-AR的16位点、27位点和164位点的基因多态性分布,分析基因多态性和哮喘发病的关系。筛选其中5～11岁共89例中度持续性哮喘儿童,采用前瞻性的药物基因学研究,予以吸入沙美特罗替卡松干粉剂治疗12周,并于治疗前后分别进行常规通气肺功能检测,分析β2-AR基因多态性对哮喘儿童吸入LABA后肺功能的影响。结果哮喘组Arg16Gly中具有G等位基因的频率高于正常对照组(分别为38.7%和31.7%,P<0.01)。哮喘组Gln27Glu中具有G等位基因的频率高于正常对照组(分别为7.1%和0,P<0.01)。164位点基因的多态性在哮喘组和正常对照组差异无统计学意义(P>0.05)。治疗后,哮喘儿童的控制率为69.66%,肺功能明显好转,第1秒用力呼出气量(FEV1),用力肺活量(FVC),呼气峰流速(PEF),呼出25%、50%、75%肺活量时的呼气流速(FEF25、50、75)均有明显改善。结论 16位点和27位点的多态性可能和汉族儿童哮喘发病有关;β2-AR基因164位点的基因多态性和哮喘无关,β2-AR基因16位点和27位点的多态性不影响哮喘患儿LABA治疗的疗效。     

吸入型糖皮质激素治疗儿童哮喘有效性与安全性的临床研究

目的　吸入型糖皮质激素作为儿童哮喘预防性抗炎治疗的第一线药物,其效应性、安全性已成为 医患双方共同关注的焦点。但目前长期吸入治疗对肾上腺皮质功能和生长发育影响的国内研究为数不多,因此我 们进行一项对照研究以观察二丙酸倍氯米松(BDP)治疗儿童哮喘的疗效及副作用。方法　50例哮喘儿童根据病 情严重程度,在快速缓解后给予不同剂量二丙酸倍氯米松吸入,为期6月～2.5年。治疗期间定期随访,观察临床 疗效,监测最高呼气流速(PEFR)值,测量体重、身高及修改吸入剂量,并进行24小时尿游离皮质醇含量测定。结 果　临床总有效率90%(45/50),与对照组[70%(21/30)]相比差异有显著性意义(P<0.05),吸入BDP后6个 月时PEFR值和初诊时相比较差异有显著性意义(P<0.05),患儿身高、体重与同龄正常值比较无异常(P> 0.05);24h尿游离皮质醇在正常范围。结论　吸入二丙酸倍氯米松治疗不同严重程度的儿童哮喘,疗效好,而且 安全。     

Le plan d''action écrit : un outil pour l''autogestion de l''asthme

Written action plans for asthma have been recommended for many years. However, despite the fact that their effectiveness has been demonstrated, they are not used enough. The plans that we propose are serviceable and the method that we suggest makes them easy to use in the treatment of asthmatic children. These plans are made for patients who do not use a peak-flow meter (plans based on symptoms) and those who control this tool (plans based on peak expiratory flow).     

Evaluation of a new method for detection of obstructive disease in children asthma: the negative expiratory pressure (NEP)]

INTRODUCTION: To take in charge of an asthmatic child it is necessary to evaluate the lung function. METHODS: In this study, the Negative Expiratory Pressure (NEP) has been used for the first time in children with asthma. After lung spirometry by plethysmography, we have used the NEP to assess the prevalence of expiratory flow limitation (FL) during resting breath in 27 asthmatic children (mean age: 11 +/- 2,5 years) 3-4 days after a crisis in both sitting and supine positions. RESULTS: All the children presented an obstructive defect (FEV 1: 63 +/- 13% med) and a dynamic hyperinflation (FRC: 128 +/- 25% med). According to the NEP, 11 children presented an expiratory flow limitation (FL). Asthma was more severe in the FL than in non-FL children (GINA 2002 classification). Among the 11 FL children, 5 were FL in both sitting and supine position and 6 only in supine. Nine of the 27 children were FL with the conventional method. NEP seems a more accurate method to assess the clinical gravity of asthma than FEV 1. The reduction of FRC in the supine position probably explains the greater incidence of FL in supine position. CONCLUSION: Because of its easy execution, NEP seems to be well adapted for children. Links between FL detected by NEP and clinical signs of asthma has to be assessed by furthers studies including more patients.     

The use of spirometers and peak flow meters in the diagnosis and management of asthma among Spanish pediatricians. Results from the TRAP study

The objective of this study was to determine the level of adherence of pediatricians in Spain to the Spanish National Guidelines for Asthma Treatment with regard to the use of a peak flow meter (PEFR) or a spirometer in the diagnosis and management of asthma in childhood and to analyze sources of variations in these practices. A prospective survey (consisting of demographic and asthma knowledge sections) was conducted over a 2-wk time interval of 3000 pediatricians throughout the country. At least one part of the questionnaire was completed and returned by 2773 individuals (92.4%), with 2347 (78.2%) answering both sections; results are for this population. Around 62% of the pediatricians reported having a peak flow meter or a spirometer in their office; however, only 33% and 48% of them used the devices for the diagnosis and treatment of asthma, respectively. There was a significant association between being older (36-55 yr old) and using PEFR or spirometry for the diagnosis (OR: 1.35, 95% CI 1.11-1.66) and the management (OR 1.47, 95% CI 1.22-1.77) of asthma. Males used a peak flow meter or a spirometer more often than females for the diagnosis (37.8% vs. 30.9%, p = 0.001) and management of asthma (52.0% vs. 45.6%, p = 0.008). Pediatricians with formal pediatric residence training used these devices more for the diagnosis (OR: 1.39, 95% CI 1.09-1.75) and management (OR: 1.58, 95% CI 1.27-1.96) than those without. Working in a hospital was also related with more peak flow meter or spirometer use than working in health centers (OR: 2.08, 95% CI 1.71-2.54 for diagnosis; OR: 1.83, 95% CI 1.50-2.22 for management). About one-third of the Spanish pediatricians surveyed use spirometers and/or peak flow meters for diagnosing asthma and about half use one of these devices occasionally for managing the disease. Independent factors favoring their use are: age 36-55 yr, male gender, working in a hospital setting, and having been trained in a formal pediatric residence program.     

Bronchial hyper-responsiveness predicts the development of mild clinical asthma within 2 yr in school children with hay-fever

In children with mild asthma, symptoms are not always apparent. Therefore, results of tests play an important role for the diagnosis. First, to investigate whether children with bronchial hyper-responsiveness (BHR) but no symptoms of asthma in 1992 had developed clinical asthma at follow up in 1994. The second aim was to find out the diagnostic properties of tests for asthma/allergic inflammation, using either doctor diagnosed asthma (DDA), self-assessed symptoms of asthma or iso-capnic hyperventilation of cold air (IHCA), as the standard, to diagnose asthma in a group of children with hay fever. Twenty-eight children with pollinosis, 12 of them with a history of asthma for the first time during the season 1992, were studied during the birch pollen season and in the autumn of 1994. During both periods, the bronchial hyper-reactivity was estimated by methacholine bronchial provocation tests (MBPT), bronchial variability by peak expiratory flow rate variability, subjective symptoms of asthma by visual analogue scale (VAS) and bronchial inflammation by serum and urine levels of inflammatory mediators. In 1994 IHCA was added during both seasons. Eight of 16 children with BHR but without clinical asthma in 1992 had developed asthma in 1994, 14 of 16 reacted to IHCA and 13 to MBPT. All 12 children with DDA in 1992 had still asthma in 1994 and 14 children with BHR in 1992 had persistent BHR in 1994. Of 23 children with BHR in 1992, 17 had DDA in 1994 and all maintained their BHR. Furthermore, 20 of them reacted to IHCA in 1994. In 1994, 24 of 28 hay-fever children had a positive IHCA tests and 24 had positive MBPT. In relation to VAS, the sensitivity of IHCA and MBPT to predict present asthma was high, but the specificity low, whereas the specificity of most other tests was high, but based on few individuals. In relation to DDA both the IHCA test (65-80%) and the MBPT test (79-85%) had a high sensitivity and it was three to six times more likely to find a positive test among asthmatics than in non-asthmatics. Children with hay fever without clinical asthma have a high risk of developing asthma within 2 yr. In relation to DDA, inhalation of cold air and the MBPT showed a high sensitivity.     

Accuracy of symptom perception in childhood asthma

Children's reports of their asthma symptoms are used as important data in the assessment and management of pediatric asthma, but little is known about the accuracy of such reports. Children's subjective perception of the level of asthma symptoms was correlated with peak expiratory flow rate measures on average of 34 observations for 37 children with asthma. Subjective/objective correlations for a given child varied from 0.86 to -0.16. The children's perceptual accuracy was not related to age or sex, or to duration or severity of asthma. Implications for clinical practice are discussed.