Objective To evaluate systematically the effect of antibiotic treatment on ventilator-associated tracheobronchitis (VAT). Methods Pubmed,Web of Science,OVID SP (ACP Journal Club,Cochrane Central Register of Contralled Trials,Embase,Medline),as well as China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data were searched for literatures about antibiotic treatment on VAT.The search deadline was March 2016.Meta-analysis was conducted with RevMan 5.3 software. Results A total of 6 studies with 769 patients were included.Among 769 patients,432 patients were treated by antibiotics,and 337 patients in control group were treated without antibiotics.Meta-analysis showed antibiotics treatment significantly reduced incidence of ventilator-associated pneumonia compared with control group [OR=0.27,95%CI (0.17,0.43),P<0.05],and shortened length of ICU stay [MD -1.51,95%CI(-2.04,-0.98),P<0.00001] .There were no significant difference in duration of mechanical ventilation [MD -2.52,95%CI (-6.85,1.81),P=0.25],mortality [OR=0.41,95%CI(0.15,1.14),P=0.09],or drug-resistant bacteria production [OR=0.62,95%CI(0.17,2.19),P>0.05]. Conclusions Antibiotic treatment can reduce incidence of ventilator-associated pneumonia in patients with VAT.Further more high quality randomized controlled trials are needed to assess the effect of antibiotic treatment on VAT.
Objective To summarize the clinical features, diagnosis and treatment of postinfection bronchiolitis obliterans. Methods Clinical manifestation, chest X-ray, characteristics of lung function,computed tomography ( CT) of 6 patients with postinfection bronchiolitis obliterans from August 2009 to June2012 were analyzed retrospectively.Results All 6 cases were diagnosed as bronchiolitis obliterans after pneumonia. One patient had severe pneumonia complicated with congenital atrial septal defect and heart failure. 3 cases were complicated with varying degrees of cardiac insufficiency. Adenovirus in sputumsample were found in2 cases, smear positive for parainfluenza virus was found in1 case, mycoplasma were found in 2 cases, and no specific pathogen was found in the last one. All 6 cases were suffered frompersistent cough,wheezing and shortness of breath with three depression sign in 4 cases. The symptoms lasted for at least 6 weeks. Crackles and wheezing were present in all 6 cases. Small airway lesion was presented by pulmonary CT. Bronchiectasis was showed in 2 cases, atelectasis in 1 case, and consolidation in 1 case. Pulmonary function tests showed mixed ventilatory dysfunction. Bronchofiberscope examination was operated in5 cases,only endotracheitis was found. Prednisone and azithromycin were given orally in all the cases, but the clinical symptoms were persistent in the course of treatment and no death occured. Conclusions Clinical symptoms of bronchiolitis obliterans are characterized by persistent cough and wheezing. Small airway lesions were present in pulmonary CT. Repeated lower respiratory infection is common. Prednisone is widely used in treatment of bronchiolitis obliterans, but the therapeutic effect is uncertain.
Objective To investigate the etiology and the clinical features of obliterative bronchiolitis (OB). Methods Sixteen admitted patients were diagnosed as OB in Peking Union Medical College Hospital from Jan 1990 to May 2018. The case records were reviewed retrospectively. Results Twelve patients were female and 4 patients were male. The median age was 33.5 years (ranged from 17 to 55). The common symptoms included: exertional dyspnea in 15 patients (94%), cough in 10 patients (63%), phlegm production in 8 patients (50%). All of the 16 patients had associated conditions: paraneoplastic pemphigus in 6 patients (Castleman’s disease, lymphoproliferative disorder, inflammatory myofibroblastic tumor and follicular dendritic cell tumor respectively), chronic graft-versus-host disease after hematopoietic stem-cell transplantation in 3 patients, thymoma in 2 patients, Behcet’s disease, Sjögren syndrome, multiple myeloma, myasthenia gravis, and oral lichen planus in 1 patient respectively. The pulmonary function tests revealed severe or very severe obstructive ventilatory defect in all 16 patients. The CT scans showed slight ground-glass opacities in 10 patients, decreased attenuation of lung in 9 patients, mosaic attenuation in 8 patients, bronchiectasis in 7 patients, and air trapping in 3 patients. Conclusions OB is a clinical syndrome characterized by progressive airway obstruction, resulting from a variety of exposures or diseases. In most cases, diagnosis can be obtained on the basis of typical clinical, physiological, and radiological features, combined with OB-related diseases or exposures. Surgical lung biopsy can help diagnosis but risk-benefit should be taken into consideration seriously.
Objective To evaluate the anti-tussive effect of a total alkaloid agent extracted from Papaver Somniferum L. on simple chronic bronchitis of which the syndrome was counterflow ascent of lung qi according to traditional Chinese medicine (TCM). Methods Randomised, double blind method, placebo control and add on design were applied. Forty-five patients with counterflow ascent of lung qi of simple chronic bronchitis were randomly divided into two groups: treatment group (n=21) with alkaloid agent and control group (n=24) with placebo. Results The incidences of obvious coughing in treatment and control groups were 66.67% and 70.83% (P=0.763 3) respectively. The cough alleviation time of patients was 14.64±16.30 h and 15.12±15.28 h (P=0.795 6) respectively. The loss of cough rates on the third day was 28.57%, 16.67% (P=0.337 7) respectively. The average scores decreased were 4.29 and 2.88 (P=0.054 8) respectively. Conclusions The study indicates that total alkaloid agent extracted from Papaver somniferum L. has no significant anti-tussive effect on patients with counterflow ascent of lung qi of simple chronic bronchitis treated with cefaclor sustained release capsules simultaneously. The trial was interrupted by the advice from experts who disagreed with the selection of drug indication.
Gibson等首先发现7例慢性咳嗽患者表现为慢性刺激性干咳或咳少许黏痰，诱导痰嗜酸粒细胞增高，糖皮质激素治疗效果良好；但患者肺通气功能正常，无气道高反应性 (AHR)，峰流速(PEF)变异率正常，无法诊断为支气管哮喘，因而称之为嗜酸粒细胞性支气管炎(EB)。研究结果发表于 1989年国际著名杂志柳叶刀(Lancet)。从Gibson等提出 EB的诊断以来，受到国内外广大专家的重视，虽然目前对 EB是否是一种独立的疾病或哮喘的早期阶段尚存在一些争议，但愈来愈多的证据表明EB是一种独立的疾病 。下面从EB的定义、病因、病理免疫特征、临床表现、治疗反应及预后等方面对此问题进行讨论，说明EB是一种独立的疾病。
Chinese medicine (CM) has significant clinical effects in the treatment of tracheal-bronchitis. It is of important clinical significance to formulate guidelines for the diagnosis and treatment of tracheal-bronchitis based on the characteristics of TCM syndrome differentiation. The Respiratory Disease Branch of China Association of Chinese Medicine and Respiratory Disease Branch of China Medical Association of Minorities organized and established a multi-disciplinary background working group, based on the World Health Organization Handbook for Guideline Development and the Guideline Development Handbook for Diagnosis and Therapy of Integrative Medicine to develop this guideline. It was developed through technical links such as clinical problem investigation, evidence collection and evaluation, Delphi consultation, and expert consensus meetings. Based on the current best evidence, CM intervention costs and expert experience, 25 recommendations were established to standardize the etiology and pathogenesis of tracheal-bronchitis, syndrome differentiation and treatment, prevention, and care, etc., which can be used by physicians at different levels of medical institutions.
目的 探讨诱导痰、痰、血清中的白介素(IL)-4、-6、-8在慢性支气管炎急性期的浓度阈值，确定其诊断意义，了解三种白介素在三种标本中的不同浓度对诊断慢性支气管炎急性期的意义。 方法 2001年1月-8月对77例慢性反复咳嗽患者按全国慢性支气管炎诊断标准确诊慢性支气管炎急性期48例，非慢性支气管炎29例，进行IL-4、-6、-8的诱导痰、痰、血清检测。采用受试者工作特征曲线(ROC曲线)鉴定三种白介素对三种标本的诊断价值。 结果 ①三种标本的三种白介素的诊断比值比(DOR)均＞3，95%可信区间的下限均＞1。②ROC曲线下面积显示：诱导痰及痰中IL-4、-8之间无差别(P＞0.05)，IL-4和IL-8分别与IL-6之间有统计学意义(P＜0.05)；血清中IL-4、-6、-8检测结果无差异(P＞0.05)。IL-4、-8的诱导痰及痰与血清有统计学意义(P＜0.05)，IL-6的诱导痰、痰、血清之间无差异(P＞0.05)。 结论 诱导痰及痰中的IL-4、-8诊断价值较好，可用于慢性支气管炎急性期的诊断。
Objective To evaluate and select essential medicine for acute bronchitis using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Eight guidelines were included (seven foreign guidelines, one domestic guideline; five based on evidence, three based on expert consensus). (2) A result of six RCTs (n=816, low quality) indicated that pentoxyverine had efficiencies of 53% to 82% for cough relief. Among the six RCTs, a result of three RCTs (n=283) indicated that pentoxyverine was slightly less efficient than procaterol (RR=0.86, 95%CI 0.78 to 0.94, P=0.001); a result of two RCTs (n=233) indicated that pentoxyverine was slightly less efficient than Chinese medicinals decoction (RR=0.82, 95%CI 0.74 to 0.91, Plt;0.001). Adverse reaction of pentoxyverine (incidence: 0% to 2.4%) mainly covered nausea, palpitation, etc. Pentoxyverine cost 0.20 yuan (for adult) or 0.08 yuan (for child) daily, which was orally taken and applicable to the target population. (3) A result of six RCTs (n=403, low quality) indicated that the efficiencies of dextromethorphan for cough relief was 47.0% to 95.3%. Among the six RCTs, a result of one RCT (n=283) indicated that dextromethorphan hydrobromide (nasal drop) was more efficient than blank intervention (RR=3.71, 95%CI 1.91 to 7.21); a result of one RCT (n=43) indicated that dextromethorphan (for oral use) was more efficient than placebo (RR=1.74, 95%CI 1.13 to 2.66); a result of one RCT (n=300, moderate quality) indicated that dextromethorphan was more efficient than pentoxyverine (RR=1.16, 95%CI 1.07 to 1.26); a result of one observational study (n=121, low quality) indicated that dextromethorphan given for 5 days had an efficiency of 66.5%. Adverse reaction of dextromethorphan (incidence: 2% to 30%) mainly covered mouth dryness, dizziness, nausea, etc. Conclusion (1) We offer a b recommendation for dextromethorphan used in relieving dry cough due to acute bronchitis. (2) We offer a weak recommendation for pentoxyverine as symptomatic treatment for cough relief. (3) We make a recommendation against antibiotics, β2-agonist bronchodilators and mucolytic agents as routine use. (4) More large-scale, multi-center, double-blinded RCTs are needed in clinical and pharmacoeconomic studies of acute bronchitis in hopes of producing high-quality local evidence.