直到10年前，慢性阻塞性肺疾病(COPD)還被認為是一種持續進展、不可逆的疾病，一個療效堪憂、前景暗淡、回報甚微的疾病[1]，正因為如此，很少開展COPD的治療性試驗。最近l0年以來在世界上的大部分國家和地區COPD已構成主要的疾病負擔之一[2,3]，帶來的直接和間接成本不斷增加，促使各國政府和醫藥企業增加了對COPD臨床試驗的投入，一系列大型國際多中心臨床試驗的結果，使我們對COPD知之不多甚至一無所知的側面有了新的認識，改變了我們固有的觀念，并勾勒出COPD未來的前景。在這一領域，中國呼吸病學T作者貢獻不多，自主開展的COPD多中心臨床試驗寥寥無幾。回顧上個世紀70年代以來COPD臨床試驗的歷程，無疑對我們有極大的啟示作用。
咳嗽是呼吸專科門診最常見的癥狀之一，其中大部分又是所謂不明原因的慢性咳嗽(unexplained chronic cough)，即常規影像學檢查未發現明確病變者。在此類慢性咳嗽當中，咳嗽變異型哮喘(CVA)是一重要病因，早年Irwin報道，慢性咳嗽的病因包括哮喘和氣道高反應(33％)、鼻后滴漏 (28％)、慢性支氣管炎(12％)、癥狀性胃食管反流(10％)、病毒感染后咳嗽(25％)，其他因素包括血管緊張素轉換酶抑制劑(ACEI)性咳嗽、精神性咳嗽(10％)以及多因素所致的咳嗽(約占20％) J。在我國尚缺乏CVA發病率的大樣本流行病學資料，最近上海同濟醫院進行了一項調查，在呼吸專科門診287例由于慢性咳嗽就診的患者當中，無論是老年人還是中青年患者，CVA均是主要的病因(老年人 34．6％ ，中青年41．5％)，其次為上氣道咳嗽綜合征(UACS， 19．3％和23．5％)、ACEI相關性咳嗽(16．3％ 和1．7％)、胃食管反流性疾病(GERD，10．6％ 和3．7％) 。由于呼吸科醫生以至普通內科醫生逐漸熟悉了解這一疾病，在門診病人當中CVA的比重越來越大，粗略估計CVA大約占不明原因慢性咳嗽病例1／3左右，占哮喘病例1／3左右。另一方面，盡管許多臨床醫生知曉CVA，但涉及其診治仍存在不少的問題。
ICS/LABA聯合治療的提出和推廣，是近十年來哮喘治療領域的一個革命性進展。然而，從LABA問世之初，圍繞LABA的爭議就始終沒有平息過。在2010年2月18日，FDA再次發出關于LABA安全性的公告。美國FDA申明LABA絕不應當（should never）單獨用于治療兒童或成人哮喘。制造商須在這類藥物產品的標簽上加入這一警示，同時采取其他步驟以減少這類藥物的過度使用。這些藥物包括單獨的LABA制劑，如施立穩（Serevent，沙美特羅）和 Foradil（福莫特羅），也包括和ICS的復合制劑如Advair（沙美特羅/氟替卡松）及信必可（布地奈德/福莫特羅）。FDA要求產品標簽反映以下信息：●如果沒有使用其他哮喘控制性藥物，如ICS，則不應當使 用LABA。LABA只能與其他控制性藥物聯合使用，不應當單獨使用。只有對那些其他哮喘控制性藥物不能取得充分控制的患者，才能夠長期使用 LABA。●使用LABA治療應當采用取得哮喘癥狀控制的最短的療程，一旦哮喘取得控制，只要有可能就應當停用。患者應當用其他的控制性藥物維持。●需要使用LABA和ICS治療的兒童和青少年患者，應當使用一種既含有ICS也含有LABA的復合制劑，以保證治療的依從性。
支氣管哮喘防治全球創議(GINA)將哮喘的嚴重程度分為三度四級，其中三級和四級屬于中度和重度哮喘。在整個哮喘人群當中，中重度哮喘大約只占1／3，但在臨床上輕度哮喘患者很少就診，中重度哮喘大約占就診患者的2／3甚至更多。中重度哮喘患者由于癥狀明顯，頻繁就診，因為哮喘控制不良，經常出現急性發作，需要住院治療，雖然人數不是很多，但占用了大部分的醫療資源。無論是從提高哮喘防治的整體水平的角度，還是從減少哮喘疾病負擔的角度，都應當將中重度哮喘作為哮喘長期管理的主要的目標人群。
根據慢性阻塞性肺疾病全球創議(GOLD)的定義，慢性阻塞性肺疾病急性加重(AECOPD)是“在COPD的自然病程中發生的事件，氣緊、咳嗽或／和咳痰等基礎癥狀加重超出正常的日間變異的范圍，急性發病，可能需要改變常規的治療”[1]。AECOPD意味著對醫療衛生資源耗用的增加，如非預約的就醫、使用藥物增加，使用抗生素或口服皮質激素甚至住院，等等。僅僅依據是否占用衛生資源來定義AECOPD并不適當，這一點還要取決于醫療衛生資源的可獲得性，同時有研究提示部分AECOPD可以是自限性的，特別是輕度急性加重。另一方面，占用醫療衛生資源的形式可以大致評估AECOPD的嚴重程度，如需要增加常規的吸人性藥物常常意味著輕度AECOPD，需要短程口服抗生素或糖皮質激素意味著中度AECOPD，而需要住院者多為重度AECOPD。AECOPD是導致COPD患者健康狀態降低乃至死亡的主要原因，也是耗用醫療衛生資源從而構成COPD疾病負擔的主要部分，需要采用有力的干預措施以降低其發生率[2]。
發生在我國汶川的5·12特大地震為里氏8.0級，造成大量人員傷亡及財產損失。據統計，截至2008年6月2日12時，此次大地震全國共有69 107人遇難，373 577人受傷，18 230人失蹤。地震發生后，國家立即動員大量人力搜救受傷人員，使部分被掩埋人員及時從倒塌廢墟中挖掘出來。同時，全國衛生系統緊急動員，對這些被搶救出的傷員進行了救治。據衛生部統計，到目前為止，因地震傷病住院治療合計92,973人，已出院68 565人，仍有11 832人住院，共救治傷員583 891人次（http://scnews.newssc.org/system/2008/06/02/010871823.shtml）。分析既往地震及其他自然災害中病人的傷害的情況及救治經驗，總結此次地震中病人受傷情況及救治過程中的得失，對我們應對以后的地震及其他自然災害有一定幫助。
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.
ObjectiveTo explore the diagnostic value of fractional exhaled nitric oxide (FeNO) in adult asthma.MethodsPubMed, Embase, Cochrane Library, Wanfang, CNKI and VIP databases were searched for relevant literatures from the time of database establishment to February 2021. Data analysis were made by Revman and Stata.ResultsA total of 44 articles with 47 records and 9654 subjects were included. The diagnosis sensitivity, specificity, positive and negative predictive value of FeNO were 0.71 (95%CI 0.65 - 0.76), 0.80 (95%CI 0.75 - 0.84), 3.47 (95%CI 2.86 - 4.21), and 0.37 (95%CI 0.31 - 0.43), respectively. The diagnostic odds ratio was 9.49 (95%CI 7.13 - 12.61), and the area under the receiver operating characteristic curve was 0.82 (95%CI 0.79 - 0.85).ConclusionsFeNO has certain diagnostic value in diagnosis of asthma. Types of asthma, region and cut-off value all have impact on the diagnostic efficiency of FeNO.
ObjectiveTo explore the application of pulmonary ventilation and perfusion imaging (V/P SPECT/CT) in quantitative evaluation of ventilation and perfusion function and its potential value in guiding local treatment of lung in patients with asthma.MethodsA total of 20 patients with asthma were included in this study. All patients underwent V/P SPECT/CT and pulmonary function test, and symptoms were assessed by the ACT questionnaire. Patients were graded for degree of airway obstruction according to V/ P SPECT/CT image visual scoring criteria. The comprehensive lung function (%) of the patients was quantitatively evaluated by combining the ventilation and perfusion defect of each lung segment in V/P imaging. The correlation between the degree of airway obstruction, comprehensive lung function, pulmonary function test and ACT score was analyzed.ResultsV/P SPECT/CT imaging can be used to grade the degree of airway obstruction in asthma patients (0-3 grade). Airway obstruction grading by V/P SPECT/CT visual score was associated with predictive forced expiratory volume in one second (FEV1%pred) of patients (r=–0.74, P<0.001). V/P SPECT/CT can also comprehensively evaluate ventilation and perfusion function in patients with asthma, and comprehensive lung function measured by this method was also correlated with FEV1%pred (r=0.629, P=0.003). V/P SPECT/CT can be used to quantitatively analyze the percentage of ventilation and perfusion function in each lung lobe. Compared with V/P SPECT/CT results, the CT volume overestimates the contribution in the upper lobes, and underestimates the lower lobes contribution to overall function.ConclusionsV/P SPECT/CT can be used as a new method to directly reflect the degree of airway obstruction in patients with asthma. Moreover, it can comprehensively and quantitatively evaluate the ventilation and perfusion function of asthma patients. V/P SPECT/CT can also be used to evaluate lobe function in patients with asthma, helping to identify the heterogeneity of changes in pulmonary function in patients with asthma, and has potential value for future treatment targeting specific areas of the lung.
ObjectiveIn order to improve the prevention and treatment of bronchial asthma, the prevalence and risk factors of asthma in Chengdu among residents over 14 years old were investigated.MethodsA cross-sectional survey was conducted in Chengdu. The inhabitants (age > 14 years) recruited in this household questionnaire survey were through multi-stage cluster random sampling. Univariate and multivariate logistic regression were used to analyze the risk factors of asthma.ResultsA total of 3 477 subjects were finally recruited in this study. Of them, 131 were asthmatic patients; and the prevalence rate was 3.8%. There were significant differences observed in the prevalence of asthma among people of different ages, residences, occupations and educational levels (χ2=191.084, P<0.05; χ2=9.114, P<0.05; χ2=114.268, P<0.05; χ2=62.123, P<0.05). Univariate regression analysis showed that the risk factors of asthma included five factors (measles, chickenpox, pneumonia, tracheobronchitis and intestinal parasitic diseases) related to childhood illness, and two factors (asthma and chronic bronchitis) related to the first-degree relatives (P<0.05). In addition, active smoking history was a risk factor for asthma in men (P<0.05). Multivariate logistic regression indicated that measles, pneumonia, tracheobronchitis, intestinal parasitic diseases in childhood and first-degree relatives suffering from asthma were independent risk factors for asthma.ConclusionsThis study describes the epidemiological characteristics of asthma in Chengdu among adolescents (age>14 years) and adults. The history of measles, pneumonia, tracheobronchitis, and intestinal parasitic diseases in childhood, and first-degree relatives suffering from asthma are the independent risk factors for asthma. In addition, active smoking history is a risk factor for asthma in men.