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.
Objective To explore the clinical value of measuring angle alpha ( α) in the descending limb of maximum expiratory flow-volumem ( MEFV) curve in chronic obstructive pulmonary disease ( COPD) and bronchial asthma. Methods From MEFV curves, angle αand other parameters were measured in 157 individuals with COPD and 149 patients with asthma who received pulmonary function test in Zhongshan Hospital, from November 2008 until December 2009. The results were grouped and analyzed.The area under ROC curve of the angle αwas measured in the patients with COPD and compared with asthma. Results The angle αlessened with the increasing degree of airway obstruction in the patients with COPD and asthma( P lt;0. 01, P gt;0. 05) . Tangent( 180 - α) and FEV1. 0 were correlated either in the COPD group or in the asthma group( r = - 0. 640, P =0. 000; r = - 0. 206, P = 0. 012) . There was no statistical difference in the angle α between the COPD group and the asthma group when the patients had mild obstructive ventilation disorders( P =0. 177) . The angle αin the COPD group was smaller than that in the asthma group when the patients had moderate and severe obstructive ventilation disorders( P =0. 000, P =0. 000) . Area under ROC curves of the angle αin the patients with COPD who had mild, moderate and severe obstructive ventilation disorders were 0. 431, 0. 846 and 0. 928 respectively. In moderate obstructive ventilation disorders, the optimal diagnostic cutoff point was 135. 5 degree which was capable of differentiating COPD and asthma with a sensitivity of 81. 7% , a specificity of 74. 2% , a positive predictivevalue of 75. 4% , and a negative predictive value of 80. 7% . In severe obstructive ventilation disorders, the optimal diagnostic cutoff point was 129. 5 degree with a sensitivity of 87. 5% , a specificity of 84. 0% , a positive predictive value of 94. 3% , and a negative predictive value of 77. 8% . Conclusions Angle αin the descending limb of MEFV curve can assess the degree of airway obstruction in COPD, whereas it just reflect the presence of airway obstruction in asthma. Differences in Angle αare associated with pathological and pathophysiological differences between COPD and asthma, which will help for deffirentiating diagnosis.
Objective To systematically assess the efficacy and safety of probiotics in prevention and treatment of bronchial asthma. Methods Randomized controlled trials (RCTs) of probiotics in prevention/treatment of asthma compared with placebo were searched in PubMed, EMbase, Web of Science, OVID and The Cochrane Library published before August 2011. The quality of the included RCTs was evaluated and the data were extracted by two assessors independently. Meta-analyses were performed with RevMan 5.1 software. Results Eleven RCTs on probiotics preventing asthma (n=3 656) and 5 RCTs on probiotics treating asthma (n=430) were identified. The Meta-analyses on preventing asthma showed that probiotics didn’t statistically decease the incidence of asthma (RR=0.76, 95%CI 0.47 to 1.22, P=0.25) and asthma-like wheezing (RR=0.92, 95%CI 0.62 to 1.39, P=0.71) compared with placebo. The Meta-analyses on treating asthma indicated that probiotics could prolong free episodes of asthma (RR=1.48, 95%CI 1.20 to 1.76, Plt;0.000 1) in comparison with placebo. No severe adverse events were found in all included studies. Conclusion The present evidence is not b enough to prove that probiotics is effective to prevent asthma, but it may prolong free episodes of asthma. Although it seems to have the effect on improving lung function, it fails to reduce the acute onset of asthma and has no have the advantage of improving immune function.
Objective To investigate and discuss the prevalence and the relevant risk factors of bronchial asthma in Shenzhen city China. Methods We used standard scheme and questionnaire, and performed stratified-cluster-disproportional-random-sampling survey for the population of five communities. Results A total of 6 248 people were surveyed. 50.5% (3 156 of 6 248) of whom were men and 49.5% (3 092 of 6 248) were women. In this survey, forty asthma patients were found, and the overall prevalence rate was 0.64%, three groups with higher prevalence were 66 to 75 years (54‰), 56 to 65 years (23‰) and 14 to 17 years (12‰) respectively. Risk factors found that among 40 asthma patients, people often exposed to secondhand smoking were reported by 40% and children exposed to their father’s smoking from fetus were reported by 57%. People with asthma with allergic rhinitis were reported by 50%. The attacks were caused by common cold and changing temperature or inhaling cold air were 45% and 30% respectively. About 86% of children suffered from asthma before 2 years old. Conclusion This survey has basically reflected the distribution, frequency and intensity of asthma. The overall prevalence rate is 0.64% from which it would be estimated that there could be 25 900 asthma patients in Shenzhen city, the relavent data will provide basis for the future research, mass prevention and the treatment of asthma.
Objective To investigate the association between polymorphism of S2 locus allele in ADAM33 gene and bronchial asthma in Xinjiang Uygur population.Methods PCR-RFLP was used to determine polymorphismof S2 locus allele in ADAM33 gene in 131 Uygur patients with bronchial asthma ( asthma group) and 90 Uygur healthy individuals ( control group) .Results The comparison of three genotypes and allele frequency of the S2 in the ADAM33 gene had statistical significance in the asthma group and the control group ( X2 =6. 065, P lt;0. 05;X2=5. 255, P lt;0. 025) . The G allele of S2 site increased the risk of asthma( OR =1. 616, P lt;0. 05) . The CG genotype also increased the risk of asthma ( OR= 1. 351,P lt;0. 05) . The FEV1% pred and FVC% pred had significant difference between three genotypes of the S2 site in the ADAM33 gene in the asthma group ( F = 6. 248, P lt; 0. 01; F = 7. 067, P lt; 0. 01) .Conclusion The polymorphism of the S2 site in the ADAM33 gene has significant correlation with asthma in Xinjiang Uygur population, and can increase risk of asthma in the Uygur population.
ObjectiveTo observe the effect of Budesonide formoterol inhalant on teenager patients with allergic rhinitis accompanied with asthma. MethodsForty-five teenager patients with allergic rhinitis accompanied with asthma treated between January 2012 and December 2013 were randomly divided into general treatment group, budesonide group and budesonide formoterol group, with 15 patients in each. Another 15 subjects undergoing physical examination were designated as the control group. Besides routine treatment, the budesonide group was also treated with budesonide inhalation at 100-200 μg twice a day, and the budesonide formoterol group was also treated with budesonide formoterol inhalation at 160 μg and 4.5 μg twice a day. The course of treatment lasted for four weeks. The patients were followed up for four weeks after the use of medicine halted. After treatment, exhaled nitric oxide (NO) examination were performed. ResultsThe amount of NO in the exhaled gas in all the three treatment groups were significantly different from the control group (P<0.05), and it was also significantly different between the Budesonide group and the budesonide formoterol group (P<0.05). ConclusionBudesonide formoterol inhalant has a good effect on teenager patients with allergic rhinitis accompanied with asthma in terms of improving exhaled NO.
ObjectiveTo analyze misdiagnosis of other lung diseases as asthma to avoid medical error. MethodsSixty-nine cases who were misdiagnosed as asthma between February 2012 and February 2014 were recruited. Clinical data was collected and analyzed including characteristics of symptoms, induced sputum, pulmonary function and blood tests. ResultsThere were 13 diseases misdiagnosed as asthma, and eosinophilic bronchitis(21.74%), upper airway cough syndrome(20.29%), chronic obstructive pulmonary disease(13.04%), allergic bronchopulmonary aspergillosis(7.25%) and hyperventilation syndrome (7.25%) were the top five diseases in these cases. Some rare diseases were also found such as idiopathic hypereosinophilic syndrome and vocal cord dysfunction. ConclusionsA variety of diseases have the similar clinical symptoms with asthma. The key to avoid and reduce misdiagnosis is to strengthen the understanding of asthma and similar diseases.
ObjectiveTo investigate the clinical manifestations, diagnosis and treatments of allergic bronchopulmonary aspergillosis (ABPA). MethodsThe clinical data of four cases of ABPA diagnosed in our department between 2009 and 2014 were analyzed. The related literature was also reviewed. ResultsABPA tends to occur in people with chronic lung diseases, such as asthma and cystic fibrosis. The main clinical manifestations are wheezing, fever, cough, and sputum production. Laboratory examinations include immediate Aspergillus skin test reactivity, elevated total serum IgE and Aspergillus specific IgE and IgG antibodies, and peripheral blood eosinophilia. Radiological findings include recurrent chest roentgenographic infiltrates and central bronchiectasis. Treatments involve corticosteroids and antifungal therapy with itraconazole. ConclusionsABPA is easy to misdiagnosis clinically. It should be considered in patients with poor controlled asthma and asthmatic patients with acute pulmonary infiltrates. Early diagnosis and proper treatment can minimize lung injury from ABPA and improve outcomes.