Objective To systematically evaluate the effectiveness and safety of omalizumab in treating allergic bronchial asthma. Methods The randomized controlled trials (RCTs) about omalizumab in treating allergic bronchial asthma were searched in databases such as MEDILINE, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data from inception to April 2013. The references of included studies and relevant conference proceedings were also retrieved manually. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then RevMan 5.1 software was used for meta-analysis. Results A total of 13 RCTs involving 4 195 patients were included. The results of meta-analysis showed that: a) Compared with the control group, the trial group revealed lower acute exacerbation of asthma during treatment (RR=0.71, 95%CI 0.65 to 0.77, Plt;0.000 01), and higher rate of patients achieved best/better results in Global Evaluation of Treatment Effectiveness (GETE) (RR=1.61, 95%CI 1.32 to 1.97, Plt;0.000 01). More patients could reduce the inhaled cortisteroid (ICS) by 50% during both treatment (RR=1.40, 95%CI 1.29 to 1.52) and 24-week follow-up period (RR=1.69, 95%CI 1.41 to 2.03). And it also increased the ratio of patients whose Asthma Quality Of Life Questionnaire (AQLQ) score got improved by 0.5 and 1.5 socres. b) There were no significant differences in the incidence of overall adverse events (RR=1.01, 95%CI 0.98 to 1.04) and severe adverse events (RR=0.94, 95CI 0.68 to 1.28). c) There might be the effects of omalzumab in improving lung function and reducing rescue medication use, but they were not obviously observed in the studies. Conclusion In the treatment of asthma, omalizumab can decrease the acute exacerbation of asthma and ICS use, and it is safer to improve the therapeutic effects and quality of life.
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 investigate the clinical characteristics of upper airway cough syndrome ( UACS) and the relationship of UACS with upper airway diseases, cough variant asthma ( CVA) , and gastroesophageal reflux disease ( GERD) . Methods 92 subjects with chronic cough and throat symptoms and signs were included in the study. The medical records were collected fromall subjects, and 49 subjects suspected for CVA undertook bronchial provocation test. Then the efficacy was evaluated and etiology were analyzed based on the efficacy of targeted treatment. Results Bronchial provocation test yielded positive results in 14 subjects suspected of CVA, accounting for 15. 2% of all cases ( 14/92) . 18. 5% ( 17 /92) of patients had a history of chronic gastritis or combined symptoms of GERD, of whom anti-gastroesophagealreflux treatment was effective. The patients with rhinitis, sinusitis history and/ or symptoms accounted for 33. 7% of cases ( 31 cases) . 51. 1% ( 47/92) of patients had only signs and symptoms of chronic pharyngitis. Conclusions UACS is not only due to the rhinitis and/ or sinusitis but also chronic pharyngitis. Chronic pharyngitis may be secondary to chronic rhinitis/ sinusitis with post nasal drip and gastroesophageal reflux, also may be an independent cause of chronic cough.
Objective To investigate the expression of aquaporin-1( AQP-1) in pulmonary tissues of asthma mice and the effects of acetazolamide( AZ) on AQP-1 expression. Methods Forty C57BL/6 mice were randomly divided into five groups. Group A was treated with phosphate buffer as a non-asthmatic group.The mice in group B, C, D, and E were sensitized with ovalbumin( OVA) and challenged with aerosol OVA to establish asthma model. The mice in group B, C, and D were interperitoneally injected with AZ at doses of 300, 200, 100 mg/kg, respectively during the challenge period. Results ①Wet/dry weight ratio of lung tissues in group E was significantly higher than that in group A( P lt;0. 05) , while it was lower in B, C and D groups than group E. ②The total number of cells, the number of eosinophils, and interleukin-5( IL-5) inBALF of group E were higher than those in group A( P lt;0. 05) , and interferon-γ( IFN-γ) level was lower in group E than in group A ( P lt; 0. 05) . After AZ treatment, the total number of cells, the number of eosinophils, neutrophils and lymphocytes were significantly decreased( P lt; 0. 05) , which were positively correlated with the dose of AZ. ③AQP-1 were expressed in tracheal epithelium, microvascular endothelial cell and bronchial peripheral vascular bed, and the expression in group E was significantly higher than that in group A( P lt;0. 01) . AQP-1 expression was significantly decreased after the intervention of AZ ( P lt;0. 05) .The decrease was positively correlated with the dose of AZ. The expression of AQP-1 mRNA showed no significant difference among these groups( P gt;0. 05) . Conclusions AQP-1 was over-expressed in the lung tissue of mice with asthma. AZ can inhibit the expression of AQP-1 and relieve lung inflammatory cells infiltrationin a dose-dependent manner. It is the protein expression of AQP-1 not the AQP-1 mRNA which were significantly different in different groups, suggesting that AZ affected AQP-1 in the post-transcriptional stage.
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 improve the knowledge of epidemiology, diagnosis and treatment of aspirin induced asthma ( AIA) in China. Methods Thirty-six cases with AIA who were reported in 30 papers in recent 10 years were analyzed retrospectively. Results The drugs which induced AIA in China mainly included acetylsalicylic acid ( aspirin) , ibuprofen ( Fenbid, ibuprofen) , while acetaminophen ( paracetamol,Bufferin, Tylenol ) , phenylpropanoid thiazide ( Piroxicam) , methoxy-naphthalene C acid ( naproxen) ,diclofenac in rare cases. 28. 6% ( 8 /28) of AIA patients were complicated with nasal disease . AIA could occur at all ages, especially for those over 40 years ( 72. 2% , 26 /36) . No significant difference of prevalencein male and female. The onset time of AIA was less than 60min in 71. 4% and gt;120min in 38. 6% . Most patients took the medications by oral ( 83. 3% ,30/36) , but the AIA onset time was not different by different administration route. Conclusions The incidence of AIA increases in recent years because of widely use of NSAIDs. However, no awareness of NSAIDs induced asthma is common in patients and physicians. For asthma patients it must be caution to take antipyretic analgesic anti-inflammatory drugs. If necessary,methoxy-naphthalene C acid ( naproxen) and diclofenac could be better choice.
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.