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A 2-year step-down withdrawal from inhaled corticosteroids in asthmatic children receiving immunotherapy

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World Journal of Pediatrics 2017年第6期13卷 560-565页

作者： Chun-Hui He Xing Li Jun-Hong Lin Qiang Xiao Jia-Lu Yu Ying-Fen Liu Wen-Hui Jiang Chen Chen Li Deng Jie Zhou Department of Respiration.Guangzhou Women and Children’s Medical Center Guangzhou Medical UniversityGuangzhouChina Institute of Human Virology Zhongshan School of Medicine.Sun Yat-Sen UniversityGuangzhouChina Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease Research.The Third Affiliated Hospital of Sun Yat—sen University Guangzhou.China

Background:inhaled corticosteroids (ICSs) for treating asthma are controversial because of their negative effects on the growth of asthmatic children and without clearly defined withdrawal strategy.A 2-year ICS step-down and withdrawal strategy has been developed for asthmatic children receiving 3-year subcutaneous immunotherapy (SCIT).Methods:Eleven children were included into the SCIT group and 13 children into the ICS *** were discontinued when children met the following criteria:requiring only 1 puff per day,with good control,for at least 6 months;having a forced expiratory volume in 1 second (FEV1)/forced vital capacity ≥80%;and SCIT discontinued for ≥24 *** main endpoints were the results of both the childhood asthma control test (C-CAT) and the methacholine bronchial provocation ***:In the SCIT group,all the 11 children had ICS discontinued,with one child developed asthma attack after pneumonia and received ICS again after completion of *** the ICS group,five children discontinued ICS and developed asthma attacks later and received ICS again;the other eight children developed severe symptoms during ICS ***,the discontinuation of ICS was only achieved in the SCIT *** dose of methacholine that caused a decrease of 20% in FEV1 continued to improve after discontinuation of ICS for the SCIT group and presented better results than the ICS group (P=-0.050).After completion of SCIT,the C-CAT had improved significantly after 30 months of treatment compared with the ICS group (P<0.05).Conclusion:In the present study,we developed a 2-year step-down and withdrawal strategy from ICSs strategy for allergic asthma children receiving SCIT;the strategy was efficacious and safe.

关键词： allergy asthma immunotherapy inhaled corticosteroid

Do inhaled corticosteroids increase the risk of Pneumocystis pneumonia in people with lung cancer?

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World Journal of Clinical Cases 2015年第9期3卷 843-847页

作者： Sameh Msaad Ilhem Yangui Najla Bahloul Narjes Abid Makram Koubaa Yosr Hentati Mounir Ben Jemaa Samy Kammoun Department of Respiratory Medicine Hedi Chaker University Hospital Department of Infectious Diseases Hedi Chaker University Hospital Department of Radiology Hedi Chaker University Hospital

Pneumocystis pneumonia(PCP) is a life-threatening infection in immunocompromised patients. It is relatively uncommon in patients with lung cancer. We report a case of PCP in a 59-year-old man with a past medical history of chronic obstructive pulmonary disease treated with formoterol and a moderate daily dose of inhaled budesonide. He had also advanced stage non-small lung cancer treated with concurrent chemo-radiation with a cisplatin-etoposide containing regimen. The diagnosis of PCP was suspected based on the context of rapidly increasing dyspnea, lymphopenia and the imaging findings. Polymerase chain reaction testing on an induced sputum specimen was positive for Pneumocystis jirovecii. The patient was treated with oral trimethoprim-sulfamethoxazole and systemic corticotherapy and had showed clinical and radiological improvement. Six months after the PCP diagnosis, he developed a malignant pleural effusion and expired on hospice care. Through this case, we remind the importance of screening for PCP in lung cancer patients under chemotherapeutic regimens and with increasing dyspnea. In addition, we alert to the fact that long-term inhaled corticosteroids may be a risk factor for PCP in patients with lung cancer. Despite intensive treatment, the mortality of PCP remains high, hence the importance of chemoprophylaxis should be considered.

关键词： Pneumocystis jiroveci Lung neoplasms Pneumonia inhaled corticosteroids Prophylaxis

Effect of inhaled interleukin-5 on activity and number of eosinophils in circulation from asthmatics

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Chinese Medical Journal 1998年第2期 31-31页

作者：施焕中谢正福肖常青覃寿明刘义

Abstract Objective To evaluate the role of interleukin 5 (IL 5) in the pathogenesis of allergic asthma, we observed the effects of recombinant human (rh) IL 5 inhalation on changes of activity and number of circulating eosinophils in allergic asthmatics, as well as concentrations of serum IgE. Methods A randomized double blind, placebo controlled study design was employed in each subject which acted as his or her own control. Eight nonsmoking asthmatics were enrolled in this study. All paients had mild atopic asthma, with baseline forced expiratory volume in 1 second (FEV 1) greater than 70% of predicted value, requiring only intermittent use inhaled β 2 agonists. Each paitent had one or more documented positive skin prick test responses to aeroallergens. None had received inhaled or oral corticoseroids in the previous 3 months. Each subject inhaled 10 μg of rhIL 5 (Genzyme Co., Boston, MA) in vehicle (0.1% bovine serum albumin in 0.9% saline) or vehicle only as a 0.5 ml nebulized solution. At least 4 weeks were allowed to elapse between the two inhalation, and the order of inhalation of rhIL 5 or vehicle was randomized. Measurements of total nuclear blood cell counts and cell differntial counts, and concentrations of eosinophil cationic protein (ECP) were performed before, and at 2, 24, and 48 h after the inhalation of rhIL 5 or vehicle. Levels of ECP in serum were determined with commercially [CD26*2〗 Department of Internal medicine, First Affiliated Hospital, Guangxi Medical University, Nanning 530021. available ECP Fluoroimmunoassay kits (Pharmacia AB, Uppsals, Sweden) according to the procedures recommended by the manufactures. All data were presented as mean±standard error of mean. Statistical analysis was done by repeated measures analysis of variance (ANOVA) for data conforming to a normal distribution, and by Friedman's test for those data with a nonparametric distribution. Results Eosinophil numbers and ECP levels within th

关键词：谢正 inhaled activity Effect

Determinants for asthma control, quality of life and use of complementary and alternative medicine in asthmatic pediatric patients in four cities

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World Journal of Pediatrics 2018年第5期14卷 482-491页

作者： Kam Lun Hon Yan Min Bao Kate C.Chan Kin Wai Chau Rong-Shan Chen Kun Tat Gary Cheok Wa Keung Chiu Li Deng Chun-Hui He Kin Mui Ieong Jeng Sum C.Kung Ping Lam Shu Yan David Lam Qun Ui Lee So Lun Lee Ting Fan Leung Theresa N.H.Leung Lei Shi Ka Ka Siu Wei-Ping Tan Maggie Haitian Wang Tak Wai Wong Bao-Jing Wu Ada Y.F.Yip Yue-Jie Zheng Daniel K.Ng Department of Pediatrics The Chinese University of Hong Kong 6/F Prince of Wales HospitalRoom 84042ShatinN.THong Kong SARChina Department ofR espiratory Diseases Shenzhen Children’s HospitalShenzhen 518026China Hong Kong Society of P ediatric Respirology and Aller gy Hong K ong S ARChina Pediatric Respiratory andSleep Disorders Center Room 1315DArgyle Centre Phase 1688 Nathan RoadMongkokKowloonHong K ong S ARChina Department of R espiration Guangzhou Women and Children’s Medical CenterGuangzhou 510623China Department of P ediatrics Kiang Wu HospitalMacaoChina Department of P ediatrics and A dolescent Medicine United Christian Hospital130Hip Wo StreetKwun TongHong K ong S ARChina Department of P ediatrics Central Hospital Conde S.JanuarioMacaoChina Department of P ediatrics and A dolescent Medicine Caritas Medical Center111Wing Hong StreetSham Shui PoHong K ong S ARChina Department of P ediatrics and A dolescent Medicine Tuen Mun Hospital23 Tsing Chung Koon RoadTuen MunNewT erritoriesHongK ongS ARChina Department of P ediatrics and A dolescent Medicine Princess Margaret Hospital2-10 Princess Margaret Hospital RoadLai Chi KokKowloonHong K ong S ARChina Department of P ediatrics and A dolescent Medicine Queen Mary Hospital102Pokfulam RoadHong K ong S ARChina Department of P ediatrics and A dolescent Medicine The University of Hong KongHong K ong S ARChina Department of P ediatrics and A dolescent Medicine Pamela Youde Nethersole Eastern Hospital3Lok Man RoadChaiwanHong K ong S ARChina Department of P ediatrics The University of Hong Kong-Shenzhen Hospital1Haiyuan 1st RoadFutianShenzhenChina Department of P ediatrics and A dolescent Medicine Kwong Wah Hospital25 Waterloo RoadKLN Hong K ong S ARChina Department of P ediatrics Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China JC School of Public Health and Primary Care Faculty of MedicineThe Chinese University of Hong KongHong K ong S ARChina Department of P ediatrics and A dolescen

Background Asthma is a significant chronic health problem worldwide. Management aims at disease control by reducing functional impairment and exacerbations and improving quality of life (QoL). We report a multi-center study to survey asthma control and QoL in four cities in the Pearl River Delta. Methods The conjoint survey involved ten Hong Kong pediatric hospitals/units, two Shenzhen hospitals, two Macao hos-pitals, and two Guangzhou hospitals on asthma control (using Asthma Control Test) and QoL (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ). Acceptability of a treatment is graded as very good/good/fair/poor. Results Good asthma control was only reported in 80% subjects in Hong Kong, but higher in sister cities (85–94%, P<0.001). Allergic rhinitis, 'incense burning', and 'smoker in family' were prevalent among the four cities. Logistic regres-sion showed better control of asthma was associated with better PADQLQ (B=?0.029, P < 0.001), better acceptability of bronchodilator (B=?1.488, P = 0.025), negatively with 'smoker in family' (B=?0.83, P = 0.015) and various PADQLQ domains. Conversely, worse PADQLQ was associated with allergic rhinitis severity (B=4.77, P <0.001), poor control of asthma (B=7.56, P <0.001), increased frequency of traditional Chinese medicine use (B=1.7, P < 0.05), increased fre-quency of bronchodilator usage (B=1.05, P < 0.05), 'smoker in family' (B=4.05, P < 0.05), and incense burning at home (B=3.9, P < 0.05). Conclusions There are some clinical and cultural differences among the four southern Chinese cities within the Guangdong province. This study identifies potentially modifiable environmental and treatment factors associated with poor asthma control and QoL for health-care interventions. Having a smoker in the family is independently associated with poor asthma control and QoL.

关键词： Asthma Complementary and alternative medicine Control inhaled bronchodilator inhaled corticosteroid Pediatric Allergic Disease Quality of Life Questionnaire Smoking Traditional Chinese medicine

Insulin therapies: Current and future trends at dawn

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World Journal of Diabetes 2013年第1期4卷 1-7页

作者： Subhashini Yaturu Endocrinology Section Stratton VA Medical Center Albany NY 12208 United States

Insulin is a key player in the control of hyperglycemia for type 1 diabetes patients and selective individuals in patients of type 2 diabetes. Insulin delivery systems that are currently available for the administration of insulin include insulin syringes, insulin infusion pumps, jet injectors and pens. The traditional and most predictable method for the administration of insulin is by subcutaneous injections. The major drawback of current forms of insulin therapy is their invasive nature. To decrease the suffering, the use of supersonic injectors, infusion pumps, sharp needles and pens has been adopted. Such invasive and intensive techniques have spurred the search for alternative, more acceptable methods for administering insulin. Several non-invasive approaches for insulin delivery are being pursued. The newer methods explored include the artificial pancreas with closedloop system, transdermal insulin, and buccal, oral and pulmonary routes. This review focuses on the new concepts that are being explored for use in future.

关键词： Diabetes Insulin therapy Insulin delivery systems Oral insulin Transdermal insulin inhaled insulin

Factors Influencing Prognosis in the Endoscopic Extraction of Foreign Bodies in Kashmiri Population

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International Journal of Otolaryngology and Head & Neck Surgery 2019年第1期8卷 32-48页

作者： M. S. Sheikh S. Gul Afshan Meelad Mohammad Sheikh S. Bunafsha Government Medical Collage R/o Gulshan Nagar Sector-C Srinagar India Women’s Medical Collage Hospital Dhaka Bangladesh Government Dhaka Medical College Dhaka Bangladesh Department of ENT Head and Neck Surgery Government Medical College Srinagar India

An updated approach in the management of 50 patients with foreign body inhalation is presented. Certain risk factors that lead to complications and mortality due to endoscopic extraction of foreign bodies and thus determine prognosis were identified. Remedial measures to reduce morbidity and mortality due to bronchoscopic removal of foreign bodies are suggested. Fifty patients of suspected foreign body inhalation presented to a Unit of the Department of ENT, Head and Neck Surgery of Government Medical College associated SMHS Hospital Srinagar, Kashmir from March 2007 to June 2017. Of these, 49 patients were subjected to rigid tube bronchoscopy for removal of the aspirated foreign bodies and one coughed out the foreign body spontaneously during admission for bronchoscopy. History of foreign body inhalation was positive in 90% of patients and remaining was mostly referred from Paediatric Units with un-resolving collapse-consolidation of the lung. Whereas plain radiography of the chest and the soft tissues of neck were the primary imaging modality used in this study to detect the inhaled foreign bodies or their effects there are reports of virtual bronchoscopy being done with a multidetector computed tomography scanner in 3D image generation from axial cuts of the internal walls of the tracheobronchial tree in the management of patients suspected with foreign body aspiration. Bronchoscopy is a difficult and potentially hazardous procedure in the infant and young child. Telescopes and telescopic forceps were used during bronchoscopy to facilitate extraction of a foreign body inhaled. The type of a foreign body, site of its enlodgement and the complications encountered during its extraction were noted. During bronchoscopy the patients were connected to an ECG monitor and a pulse oximeter. 80% of the patients with foreign body inhalation were children in the age group of 0 - 5 years. There was a definite history of choking over the foreign body in 88% of the patients lead

关键词： inhaled Foreign Bodies Collapse-Consolidation Obstructive Emphysema Virtual Bronchoscopy Rigid Tube Bronchoscopy Hypoxic Bradycardia Bronchospasm Subglottic Oedema Pneumothorax Tracheostomy Prognosis

Recurrent pulmonary embolism in a boy with antiphospholipid syndrome

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Case Reports in Clinical Medicine 2013年第5期2卷 310-314页

作者： Christian Müller Christian Willaschek Mathias Borst Reiner Buchhorn Department of Medicine Caritas Krankenhaus Bad Mergentheim Germany Department of Pediatrics Caritas Krankenhaus Bad Mergentheim Germany Department of Pediatrics Caritas Krankenhaus Bad Mergentheim Germany

We report a 14-year-old patient with recurrent pulmonary embolism due to catastrophic antiphospholipid syndrome (APS) with severe pulmonary inflammation. We considered elevated antibodies against cardiolipin and anti-beta2-glycoprotein-1, but no clinical nor laboratory manifestations of systemic lupus erythematosus (SLE). Pulmonary embolism had been the first manifestation of catastrophic APS in this patient. We prescribed warfarin and systemic corticosteroids. A second embolism appeared during anticoagulation with warfarin. This event led to a marked decrease of his physical performance due to his obstructive and restrictive lung disease. Anticoagulation was changed from enteral warfarin to subcutaneous enoxaparine. We also prescribed inhaled corticosteroid which led to an improvement of his respiratory symptoms and overall poor physical condition.

关键词： Pulmonary Embolism Antiphospholipid Syndrome APS inhaled Corticosteroid