Objective To systematically evaluate the effectiveness and safety of omalizumab in treating allergic bronchial asthma. Methods The randomized controlled trials (RCTs) about omalizumab in treating allergic bronchial asthma were searched in databases such as MEDILINE, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data from inception to April 2013. The references of included studies and relevant conference proceedings were also retrieved manually. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then RevMan 5.1 software was used for meta-analysis. Results A total of 13 RCTs involving 4 195 patients were included. The results of meta-analysis showed that: a) Compared with the control group, the trial group revealed lower acute exacerbation of asthma during treatment (RR=0.71, 95%CI 0.65 to 0.77, Plt;0.000 01), and higher rate of patients achieved best/better results in Global Evaluation of Treatment Effectiveness (GETE) (RR=1.61, 95%CI 1.32 to 1.97, Plt;0.000 01). More patients could reduce the inhaled cortisteroid (ICS) by 50% during both treatment (RR=1.40, 95%CI 1.29 to 1.52) and 24-week follow-up period (RR=1.69, 95%CI 1.41 to 2.03). And it also increased the ratio of patients whose Asthma Quality Of Life Questionnaire (AQLQ) score got improved by 0.5 and 1.5 socres. b) There were no significant differences in the incidence of overall adverse events (RR=1.01, 95%CI 0.98 to 1.04) and severe adverse events (RR=0.94, 95CI 0.68 to 1.28). c) There might be the effects of omalzumab in improving lung function and reducing rescue medication use, but they were not obviously observed in the studies. Conclusion In the treatment of asthma, omalizumab can decrease the acute exacerbation of asthma and ICS use, and it is safer to improve the therapeutic effects and quality of life.
ObjectiveTo explore the clinical features of atypical bronchial asthma with chief complaint of palpitations. MethodsTwelve cases with unexplained palpitations diagnosed by asthma were analyzed retrospectively. ResultsThe patients were diagnosed with asthma through bronchodilation test,skin prick tests,fractional exhaled nitric oxide (FeNO) and diagnostic treatment.The ratio of male to female cases was 1:5. The ventilation lung function of all patients was in normal range. The median time of misdiagnosis was 13.5(3-120) months. 41.6% of cases had dust mite positive skin prick test. The median value of FeNO was 32.75(18-54) ppb. The symptoms of all patients were relieved completely after standard treatment. ConclusionPalpatation may be a specific presentation of asthma characterized with eosinophilic airway inflammation which may be misdiagnosed as other diseases for a long time,especially in elder women. To improve the knowledge of this kind of atypical asthma,detailed medical history, experimental examinations and diagnostic treatment response are important to confirm the diagnosis in time.
Objective To assess the systematic reviews of magnesium sulfate used to treat severe asthma. Methods An electronic search was performed in The Cochrane Library (Issue 2, 2008), ACP Journal Club (1991 to June 2008), MEDLINE (1990 to June 2008), Chinese Journal Full-text Database (1979 to June 2008), Chinese Scientific and Technological Periodical Databases (VIP) (1980 to June 2008), and Chinese Bio-medicine Database (CBM) (1980 to June 2008) to collect systematic reviews of magnesium sulfate treatment for severe asthma. The retrieved systematic reviews were reassessed, and then we adopted the evidence for clinical practice. Results Nine systematic reviews were included, and all of them included 14.1 ± 2.9 items of QUOROM (the quality of reporting of Meta-analyses) on average. In general, the included systematic reviews had comparatively high quality. Evidence illustrated that intravenous infusion of magnesium sulfate could improve pulmonary function and reduce hospital admission without any serious side effects. However, no evidence could verify that patients with asthma can benefit from aerosolized and oral magnesium sulfate. In a specific case with severe asthma, we used magnesium sulfate via intravenous infusion which helped the control of symptoms with no adverse reactions. Conclusion Magnesium sulfate via intravenous infusion can improve pulmonary function and reduce hospital admission rates. Due to its effectiveness, safety, and low cost, it deserves widespread application in patients with severe asthma.
ObjectiveTo explore the predictive value of fractional exhaled nitric oxide (FeNO) in the treatment response of adult asthmatic patients. Methods64 adult outpatients with asthma from Peking Union Hospital between March and September 2013 were recruited in the study. All patients completed asthma control test (ACT) together with exhaled nitric oxide (FeNO) and pulmonary function test. Then the patients were classified into a higher FeNO group (n=33) and a normal FeNO group (n=31) according to FeNO level. All patients accepted regular inhaled ICS/LABA treatment (salmeterol and fluticasone 50/250). Three months later all patients reaccepted ACT,FeNO and pulmonary function test. ResultsThe ACT score increased in all patients,and was significantly higher in the higher FeNO group than that in the normal FeNO group[22.07±5.49 vs. 19.23±5.48,t=2.893,P<0.05]. The complete control rate of the higher FeNO group was higher than that in the normal FeNO group (42.42% vs. 19.35%,χ2=3.960,P<0.05). The FEV1 and FEV1%pred of two groups both increased significantly (P<0.05),but there was no significant difference between two groups (P>0.05). Correlation analysis showed that FeNO and the declined rate of FeNO was negatively correlated with the ACT score(r=-0.302,P<0.05;r=0.674,P<0.01) and positively correlated with the improvement of ACT score (r=0.514,P<0.01;r=0.674,P<0.01). No significant correlation was found between FeNO and FEV1 or FEV1%pred. ConclusionThe effect of ICS/LABA therapy is better for asthma patients with higher FeNO. FeNO can be used for predicting the response to ICS/LABA therapy in patients with asthma and guiding the treatment.
Objective To explore the clinical features and diagnostic procedure of atypical asthma characteristic of chest pain.Methods The patients with unexplained chest pain were screened by lung function test and bronchial provocation test.The diagnosis of asthma was established by therapeutic test and exclusive procedure.The clinical manifestations were analyzed.Results In 56 cases of unexplained chest pain 20 cases were diagnosed as asthma.While all patients referred to clinic with chest pain as chief complaint，a majority of patients (11 cases，85%) showed obscure chest tightness，breath shortness and cough..Some cases reported the same trigger factors as asthma.Chest pain was relieved in all cases after regular antiasthma treatments.Conclusions Chest pain could be a specific presentation of asthma which may be misdiagnosed as other diseases.Bronchial provocation tests and antiasthma therapy should be considered to screen and diagnose this atypical asthma.
Objective To investigate the changes of small airway function and diffusing capacity in patients with mild asthma before and after bronchial provocation test (BPT).Methods BPT was performed in suspected asthma patients with chief complaints of paroxysmal wheeze,chest tightness and cough，but with normal chest X-ray and baseline pulmonary function.BPT positive group was regarded as asthma group，while BPT negative group as control group.Lung volume，ventilatory function and diffusing capacity were measured before and after BPT and compared between the asthma and control groups.Results （A）No statistical differences were found in FEV1%，FEV1/FVC，FVC%，VC%，TLC%，FRC%，RV%，RV/TLC between the asthma and control groups before BPT.FEV1/FVC and FVC% were significantly decreased (all Plt;0.01)，while FRC% (Plt;0.05)，RV% (Plt;0.01) and RV/TLC (Plt;0.01) increased significantly in the asthma group after BPT compared with the control group.The decline rate of FEV1/FVC and FVC% and the increase rate of TLC%，RV%，RV/TLC were significantly higher in the asthma group than those in the control group (all Plt;0.01).（B）Compared with the control group，FEF25%-75% (Plt;0.05)，Vmax75% (Plt;0.01) and Vmax50% (Plt;0.05) were significantly lowered before BPT，while the above parameters and Vmax25% were significantly decreased after BPT in the asthma group (all Plt;0.01).The decline rate of FEF25%-75%，Vmax75%，Vmax50% and Vmax25% was significantly higher in the asthma group than those in the control group (all Plt;0.01).（C）There was no statistical difference in DLCO in both groups before and after BPT.Conclusions Patients with mild asthma had small airways impairment before BCT which further declined after BPT.However,no impairment of diffusion capacity was found before or after BPT.
Objection To investigate the changes of insulin and insulin receptor in asthma patients.Methods Forty asthma patients were allocated into two groups：20 newly diagnosed treatment–naiuml;ve mild-moderate asthma patients，20 mild-moderate persistent asthma patients treated with inhaled corticosteroid. 20 healthy volunteers were enrolled as normal control.Blood samples were obtained from 40 asthma patients and 20 healthy volunteers.Total and differential leukocyte counts,blood glucose concentration and serum insulin concentration were measured.The level of lymphocyte insulin receptor in peripheral blood were assayed by flow cytomertry.Pulmonary function were performed at the same time.Results The numbers of eosinophil in the two asthma groups were significantly higher than those in the normal control group [(4.04±2.57)% and (4.24±2.34)% vs (0.90±1.38)%，Plt;0.05)，the levels of insulin and insulin receptor in the treatment-naiuml;ve group were significantly higher than those in the control group [insulin：(13.00±5.20)mIU/L vs (10.08±3.79)mIU/L，Plt;0.05；insulin receptor：(2.59±3.11)% vs (0.99±0.62)%，Plt;0.05).Conclusion Insulin secretion and insulin receptor expression in asthma patients are increased in the presence of inflammation.
2007年1月6日、13日，国内部分呼吸病学专家分别在广州和上海举行(2006年全球支气管哮喘防治创议(GINA)》研讨会。新年伊始的两次最重要的学术活动均围绕着GINA展开，充分说明我国呼吸学界对此次新版GINA的极大兴趣和高度重视。
Objective To evaluate the status of asthma control in asthmatic outpatients.Methods We performed an investigation by a questionnaire in a face-to-face setting from Feb 2006 to May 2006 in asthmatic outpatients of China-Japan Friendship Hospital.Results A total of 101 asthmatic patients were investigated with a mean age of 47±14.8 years and course of disease of 9.1±12.8 years.80.2% of the asthmatic patients had various social insurance.40.6% of the respondents had visited emergency department because of asthma exacerbation.The percentage of adults with lost workdays caused by asthma was 61.7% (29/47)，and which of children with lost schooldays was 75% (3/4).37.6% of asthmatic patients were completely controlled.Approximately three fourth of respondents (75.2%) was either well or completely controlled.72.3% of respondents had undergone a lung-function test during the past year.The one third of respondents (36.6%) owned oneself peak flowmeter.Only 12.9% reported kept regular use of peak flowmeter.87.1% of patients use inhaled corticosteroids (ICS) regularly.Conclusion With the implementation of patient education program and asthma guideline，the asthma control level has been further improved.