Objective To systematically evaluate the efficacy and safety of montelukast in the treatment of acute asthma in adults.Methods Randomized controlled trials ( RCTs) of montelukast in the treatment of acute asthma compared with placebo were searched in Pubmed, Embase, OVID, and Cochrane Library. The quality of included RCTs was evaluated and the data were extracted. Meta-analyses were performed with RevMan 5. 1 software, and the GRADE system was applied to rate the level of evidence and strength of recommendation. Results Five RCTs ( n = 947) were included. Meta-analyses showed that montelukast could statistically improve peak expiratory flow ( PEF) ( MD = 10. 65 [ 2. 81, 18. 49] , P = 0. 008) , reduce the number of patients with oral corticosteroids ( RR=0. 75[ 0. 62, 0. 92] , NNT= 7[ 4, 46] , P =0. 005) , but there were no statistical differences in decreasing the number of patients with hospitalizations ( RR= 0. 78[ 0. 57, 1. 06] , NNT = 19[ 9, + ∞] , P = 0. 110) and treatment failure ( RR = 0. 85[ 0. 67, 1. 09] , NNT=17[ 9, +∞] , P =0. 314) compared with the placebo. Based on GRADE, the level of evidence was low or moderate, and the strength of recommendation was weak. Conclusion Our study suggests montelukast can improve the lung function and reduce the use of systematic corticosteroids in acute asthma, but the potency to reduce the number of patients with hospitalization and treatment failure need to be explored in future.
ObjectiveTo study the characteristics of patients hospitalized for asthma exacerbation during 2013-2014 in China-Japan friendship hospital.MethodsThis was a retrospective study involving patients hospitalized for asthma exacerbation in China-Japan friendship hospital during 2013–2014. Information about the demographic features, conditions before the admission, the treatment, the complications and the outcome were collected using the pre-designed case report form.ResultsThe patients hospitalized for asthma exacerbation accounted for 7.5% (250/3 326) of the total patients admitted to the respiratory department. September was the peak month when the most asthmatic patients were admitted to the hospital. A total of 99 asthma patients were included for further analysis and consisted of 12 mild-onset, 22 moderate-onset, 62 severe-onset and 3 life threatening-onset. There were 49.5% (49/99) patients who had a history of previous hospitalization or emergency department visits during the last year. There were up to 54.5% (54/99) of patients who didn't use inhaled corticosteroids before the admission. Only one patient died during the hospitalization. The mortality was 1.0%.ConclusionsThe number of asthmatic patients admitted to the hospital fluctuates with seasons, and September is the peak month. Only a small part of patients use asthma controllers regularly before the admissions.
ObjectiveTo explore whether education and management of medical care integration can improve asthma control. MethodsA prospective, 12-month, cohort study was undertaken in a real-world setting based on Australasian severe asthma network (ASAN). A total of 516 patients with stable asthma were consecutively recruited, who received education and management of medical care integration, and step-wise anti-asthma regimens determined by physicians’ standard practice. Furthermore, inhaled corticosteroid (ICS) adherence, lung function, asthma symptom control and exacerbation were assessed at 1, 3, 6, and 12 months. ResultsAt the end of 12 months, ICS adherence (47.7% vs. 81.5%, P<0.05), lung function, and asthma symptoms were assessed by asthma control text (ACT) [20 (16, 23) vs. 23 (21, 24), P<0.05], which were significantly improved in comparison to the status at baseline, and 86.0% of patients achieved total/well-controlled level of asthma. The exacerbation (14.2% vs. 36.2%, P<0.01) and hospitalizations (8.5% vs. 15.3%, P<0.01) because of asthma for the following year significantly decreased compared with those in the past year. The multivariate regression analysis indicated that poor ICS adherence (RR=1.52, 95%CI 1.02 to 2.25, P=0.039), depression symptoms (RR=1.19, 95%CI 1.05 to 1.34, P=0.007), and exacerbation during the past year (RR=2.81, 95%CI 1.49 to 5.27, P=0.001) were associated with an increased risk of future exacerbation. ConclusionIn a real-world setting, most of asthmatics achieve total/well-controlled asthma by education and management of medical care integration including shared decision-making between physicians and patients and step-wise anti-asthma regimens. ICS adherence and depression symptoms independently predict asthma exacerbations, and strengthening education and management of medical care integration, esp. psychological nursing, would improve asthma control levels.
Objective To investigate the effects of a mixed bacterial lysate (OM-85 BV) on lung function and serum IgE in asthmatic mice under acute attack, and to explore the therapeutic effect of OM-85 BV on acute attack and the application value of OM-85 BV in non-acute attack. Methods A total of 30 SPF Kunming mice aged 4 to 6 weeks were randomly divided into 3 groups, namely a blank control group (Group A), an asthma model group (Group B), and an OM-85 BV intervention group (Group C). The mice in groups B and C were sensitized by intraperitoneal injection of ovalbumin on day 1, 8 and 15, respectively. From day 22, the asthma model was stimulated by inhalation of 5% ovalbumin every day for 30 min for 5 consecutive days. The mice in group C were treated with OM-85 BV dissolved in normal saline from day 1, and each mouse was gavaged continuously for 10 days. The intraperitoneal injection, intragastric administration and aerosol inhalation reagent of mice in group A were all replaced by normal saline, while the intragastric administration of mice in group B was replaced by normal saline. One hour after the last stimulation, the mice were anesthetized, their lung function was measured, blood was collected from the eyeballs and then they were sacrificed, and the blood was centrifuged and the serum was separated and stored. Hematoxylin and eosin staining was used for pathological examination. Serum IgE was determined by enzyme-linked immunosorbent assay. Results Compared with group A, forced vital capacity in 0.15 second (FEV0.15), FEV0.15/forced vital capacity (FVC) and peak expiratory flow (PEF) of mice in group B were significantly decreased. The lung function of group C was improved compared with group B. In group B, the pathological manifestations were dysplasia and collapse of bronchial epithelium, infiltration of inflammatory cells, mainly lymphocytes and eosinophils, a small amount of mucus and shed epithelial cells in the tracheal lumen, and significant thickening of airway wall. The asthma mouse model was well established. The pathological manifestations of airway in group C were less severe than those in group B, the thickness of airway wall was reduced, and the inflammatory cells were also significantly reduced. The serum IgE concentration in groups B and C increased, and the IgE level in group C decreased significantly compared with group B. The differences were statistically significant (all P<0.05). Conclusions Exogenous administration of OM-85 BV in asthmatic mice can effectively reduce the concentration of serum IgE, alleviate airway inflammation, reduce eosinophil infiltration, and improve the pulmonary function performance of asthmatic mice during acute attack, showing that FEV0.15/FVC, FEV0.15 and PEF indicators are significantly improved. OM-85 BV can alleviate the symptoms of bronchial asthma in the acute attack of mice, improve the physiological function of the lung during the acute attack, inhibit airway inflammation, and have certain application value in the stable asthma control.