Detection Of Treatment Adherence, Disease Control and Its Predictors in Asthma Patients by Rural Community Level Health Workers

Background: Despite the availability of effective therapy, disease control in Asthma remains suboptimal with high morbidity. Objectives: To assess treatment adherence, asthma control and its influencing fac-tors.Methodology: A prospective, observational study was conducted among 152 adult asthma patients re-porting consecutively to a BPHC for twelve months. Patients were followed up by trained healthcare workers to assess their treatment adherence and disease control using a predesigned, pretested and val-idated questionnaire.Results: Mean age was 49.6 years (SD=+14.0), males reported more cases (73.7%), addiction to tobacco was high (48.7%). 40.8% patients had high treatment adherence. Only 37.5% patients reported good asthma control of which 68.4% showed high adherence. The mean Asthma Control Test (ACT) score was 18.75 ± 4.8 SD. Increasing age (aOR=0.96, 95% CI= 0.93-0.99), tobacco smoking (aOR=2.90, 95% CI=1.20-6.99), dust allergy (aOR= 7.92, CI =3.15-19.91) and low treatment adherence (aOR=5.33, 95% CI=2.22-12.82) were found to be significant predictors of poor disease control.Conclusions: Non adherence to treatment and poor disease control was high among rural asthma pa-tients. Patient education for tobacco cessation and treatment compliance along with periodic monitoring undertaken by trained health workers can be an effective strategy to reduce disease burden in the com-munity.

Application of fractional exhaled nitric oxide and nasal nitric oxide in control evaluation of bronchial asthma and diagnosis of allergic rhinitis in children / 中国当代儿科杂志

OBJECTIVES@#To study the association of fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) with asthma control and their value in the diagnosis of allergic rhinitis in children.@*METHODS@#A total of 186 children aged 5-12 years, who attended the outpatient service of the Department of Respiration, Shanghai Children's Hospital due to bronchial asthma and/or allergic rhinitis or who underwent physical examination, were enrolled as subjects, with 52 children in the asthma group, 60 children in the asthma+allergic rhinitis group, 36 children in the allergic rhinitis group, and 38 children in the control group. FeNO, nNO, and pulmonary function were compared between groups.@*RESULTS@#The asthma+allergic rhinitis, asthma, and allergic rhinitis groups had a significantly higher level of FeNO than the control group (P<0.05). The asthma+allergic rhinitis and allergic rhinitis groups had a significantly higher level of nNO than the asthma and control groups (P<0.05). The uncontrolled asthma and partially controlled asthma groups had significantly higher levels of FeNO and nNO than the completely controlled asthma group (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that nNO had an area under the ROC curve of 0.91, with a sensitivity of 80.0% and a specificity of 89.5% in the diagnosis of allergic rhinitis in children with asthma (P<0.05).@*CONCLUSIONS@#The combined measurement of nNO and FeNO can be used to evaluate the control of asthma, and the measurement of nNO can help with the diagnosis of allergic rhinitis in children with bronchial asthma.

Current status of asthma control and influencing factors of occupational sensitizer-induced asthma / 中国职业医学

OBJECTIVE: To investigate the asthma control status of occupational sensitizer-induced asthma(OSIA) and explore the influencing factors. METHODS: A total of 50 OSIA patients were selected as study subjects by judgment sampling method. Asthma Control Test(ACT) and Asthma Quality of Life Questionnaire were used to investigate the asthma control status and the quality of life of patients. The fractional exhaled nitric oxide(FeNO) level, pulmonary function, peripheral blood eosinophil ratio(EOS%)and serum total immunoglobulin E(IgE) level of the patients were measured. RESULTS: Among the 50 cases of OSIA patients, 27(54.0%) cases were well controlled, and 23(46.0%) cases were non-fully controlled. The patients with allergic rhinitis, with no inhaled corticosteroids treatment and with poor compliance were risk factors of the non-fully controlled OSIA(all P<0.05). The scores of ACT and the quality of life, and the percentage of the first second forced expiratory volume(FEV_1%) decreased(all P<0.05), while the level of FeNO increased(P<0.05) in the non-fully controlled group compare with the well-controlled group. There was no statistical significance in EOS% and serum total IgE level between the two groups(both P>0.05).CONCLUSION: Allergic rhinitis, lack of inhaled corticosteroids treatment and poor compliance are the influencing factors that affect the control of OSIA. The combinational scores of ACT and quality of life, FeNO, FEV_1% and other indicators can reflect the status of OSIA and assess the level of asthma control, and help guiding OSIA diagnosis and treatment plans.

Correlation among fractional exhaled nitric oxide, child asthma control test, lung function and disease severity in children with asthmatic / 中国医师进修杂志

Objective To investigate the correlation among fractional exhaled nitric oxide (FeNO), child asthma control test(C-ACT) and lung function in asthmatic children and its clinical significance. Methods A total of 108 cases of asthmatic children in the Affiliated Hospital of Qingdao University from June 2016 to September 2018 were recruited. Forty-seven cases (47.44%) were in acute onset, 40 cases(40.37%) were in chronic persistent, and 21 cases (21.19%) were in paracmasis. FeNO, lung function and C-ACT score were measured, and the correlation among them was analyzed. Results The level of FeNO in acute onset patients and chronic persistent patients had no significant difference:(44.18 ± 25.47)×10-9 vs. (46.98 ± 27.50)×10-9, P>0.05, but the level of FeNO in paracmasis patients was lower [(24.43 ± 10.71) × 10-9], compared with that of acute onset patients and chronic persistent patients, there were significant differences (P < 0.01). The scores of C-ACT in three groups had significant difference (P < 0.01), and there were significant differences between any two groups (P <0.01). The levels of forced expiratory peak flow rate measured value as a percentage of predicted value (FEV1%) and forced expiratory volume and forced vital capacity ratio in the first second (FEV1/FVC) in acute onset patients were significantly lower than those in chronic persistent patients and paracmasis patients (P <0.01), and there were no significant differences between chronic persistent patients and paracmasis patients (P＞0.05). Conclusions Compared with lung functions and C-ACT, FeNO is a good biomarker to evaluate the airway inflammation of asthmatic children.

Usefulness of bronchodilator response as an index of asthma control in children

PURPOSE: Assessing asthma control is important for proper management, and various indices for objective assessment of asthma control, such as fractional exhaled nitric oxide (FeNO) and asthma control test (ACT) score have been proposed. Recently, bronchodilator response (BDR) was reported as a marker of poor asthma control in adults. This study aimed to assess the usefulness of BDR as a biomarker for childhood asthma. METHODS: A total of 305 children diagnosed with asthma were included. Spirometry with bronchodilator test was done at the time of diagnosis and about 14 months after asthma treatment. All children were evaluated by childhood asthma control test (c-ACT) and FeNO after asthma treatment. The patients were divided into 2 groups according to BDR results: the positive and negative BDR groups. Various biomarkers for asthma control, such as c-ACT, FeNO and changes of forced expiratory volume in 1 second (FEV1), were compared between the 2 groups. RESULTS: Of the 305 patients, 143 (46.9%) were positive and 162 (53.1%) were negative for BDR. The BDR-positive group showed lower FEV1. In the BDR positive group, FEV1 was significantly increased after asthma treatment, especially in children with airflow limitation which was defined as below 80% of FEV1 or atopy. In atopic children, BDR showed a significant negative correlation with c-ACT and a positive correlation with FeNO. CONCLUSION: In asthmatic children with airflow limitation at the time of diagnosis, BDR can be a useful index for predicting improvement in lung function by asthma maintenance treatment. BDR could be a reliable marker for the assessment of asthma control in atopic children.

Multimedia combined with health education manual for children with bronchial asthma / 中国实用护理杂志

Objective To analyze the effects of multimedia combined with health education manual on ACT score, family knowledge and compliance with standard treatment for children with bronchial asthma. Methods The clinical data of 82 children with bronchial asthma who had received treatment in the hospital between October 2017 and March 2018 were randomly selected, among which the children who had received treatment between October 2017 and December 2017 were set as the control group (n=41) and those who had received treatment between January 2018 and March 2018 as the study group (n=41). Oral health education was applied in the control group, whereas multimedia combined with health education manual were given to the study group. The clinical application effects in the two groups were compared. Results The scores of ACT (Asthma Control Test), Initiative Clause Sociale (ICS), and satisfaction degree in the study group were 23.30±3.74, 11.10±2.20, 95.08±3.33, significantly higher than 18.23±2.62, 6.69±2.12, 72.11±3.24 in the control group (t=7.109, 9.243, 31.656, P<0.01). The family mastery of knowledge in the control group was 73.13% (30/41), lower than that in the study group, which was 95.12% (39/41) (χ2=7.405, P<0.05). The rate of complete compliance with treatment accounted for 87.80% (36/41) in the study group, higher than 60.98% (25/41) in the control group, and the difference was statistically significant (χ2=7.746, P<0.05). Conclusion For children with bronchial asthma, the combination of multimedia and health education manual intervention can help increase the knowledge and asthma control ability of their parents, as well as their compliance with treatment.

Value of fractional exhaled nitric oxide in diagnosing of eosinophils bronchial asthma and in appraising of therapeutic reaction of inhaled corticosteroids for eosinophils bronchial asthma / 新乡医学院学报

Objective To determine the diagnostic value of ractional exhaled nitric oxide (FeNO) in eosinophils (EOS) bronchial asthma and its significance in appraising of therapeutic reaction of inhaled corticosteroids (ICS) for EOS bronchial asthma.Methods A total of sixty-two patients with bronchial asthma in the First Mfiliated Hospital of Xinxiang Medical University from April 2015 to February 2016 were selected as asthma group;at the same time,sixty-two healthy people were recruited as control group.The patients in asthma group were divided into EOS asthma group(n =31) and non EOS asthma group (n =31) according to the induced sputum cell count;the patients in EOS asthma group were divided into mild (n =7),moderate (n =13) and sever asthma group (n =1 1) according to the severity of the disease.The patients in asthma group were given conventional therapy(doxofylline 0.2 g intravenous infusion,two times per day;oral cetirizine 10 mg,one time per night;oral montelukast 10 mg,one time per night;budesonide 2 mg and compound ipratropium bromide solution 2.5 mL by aerosol rebreathing method,two times per day) for seven days.The pulmonary function,asthma control test(ACT) score,FeNO level and the ratio of EOS of patients were detected before and after treatment;the FeNO levels of person in the control group were tested.The FeNO levels of subjects were compared in each group;the correlation between FeNO level and EOS ratio was analysed in asthmatic group;the controlling rates of patients in asthmatic group were compared.Results Before treatment,the FeNO level in control group and asthma group was (9.57 ± 6.61),(30.23 ± 8.9 1) ppb respectively;the FeNO level in control group was significantly lower than that in asthma group (t =7.414,P ＜ 0.05).Before treatment,the FeNO level of patients in EOS asthma group and non EOS asthma group was (59.62 ± 29.04),(18.20 ± 11.33) ppb respectively;the FeNO level in non EOS asthma group was lower than that in EOS asthma group (t =6.568,P ＜ 0.05).In asthma group,the level of FeNO was positively correlated with EOS ratio(r =0.823,P ＜ 0.05).There was no statistic difference in FeNO level of patients in non EOS asthma group before and after treatment(t =2.013,P ＞ 0.05).The FeNO levels of patients in EOS asthma group after treatment were significantly lower than those before treatment (t =7.740,P ＜ 0.05);the FeNO levels of patients in mild,moderate and sever asthma group after treatment were significantly lower than those before treatment(t =3.535,8.171,7.161;P ＜0.05).The control rate of patients in EOS asthma group(67.7％,21/31) was significantly higher than that in the non EOS asthma group(22.6％,7/31) (x2 =12.765,P ＜0.05).The control rate of patients in mild,moderate and sever asthma group was 28.6％ (2/7),76.9 ％ (10/13) and 81.8 ％ (9/11) respectively;the control rate of patients in mild asthma group was significantly lower than that in moderate and sever asthma group (x2 =6.418,7.103;P ＜ 0.05);there was no statistic difference in control rate of patients between moderate asthma group and sever asthma group(x2 =7.103,P ＞ 0.05).Conclusion FeNO level can reflect the degree of airway inflammation,and can be used for the diagnosis of EOS phenotype asthma,and also has certain clinical value in evaluating the therapeutic reaction of ICS for treatment of EOS asthma.

Observations on the Therapeutic Effect of Combined Moxibustion and Medicine on the Clinical Remission Stage of Bronchial Asthma / 上海针灸杂志

Objective To investigate the clinical efficacy of gentle moxibustion plus oral Gushen Dingchuan pills in treating the clinical remission stage of bronchial asthma.Methods Ninety patients with bronchial asthma in the clinical remission stage were randomized to groups A,B and C,30 cases each.group A received moxa-stick gentle moxibustion;group B,oral administration of Gushen Dingchuan pills;group C,moxa-stick gentle moxibustion plus oral administration of Gushen Dingchuan pills.The course of treatment was three months in all the three groups.The TCM symptom score and the Asthma Control Test (ACT) score were recorded and serum immunoglobulin E (IgE) content was measured in the two groups before and after treatment.The clinical therapeutic effects were compared between the groups.Results The total efficacy rate was 76.7％ in group A,80.0％ in group B and 93.3％ in group C.there was a statistically significant difference in the total efficacy rate between group C and group A or B (P＜0.05).There were statistically significant pre-/post-treatment differences in the TCM symptom score,the ACT score and serum IgE content in all the three groups (P＜0.01).There were statistically significant post-treatment differences in the TCM symptom score,the ACT score and serum IgE content between between group C and group A or B (P＜0.01,P＜0.05).Conclusion Gentle moxibustion plus oral Gushen Dingchuan pills can improve immunologic function in patients with bronchial asthma in the clinical remission stage.

Therapeutic Observation of Wheat-sized Moxibustion in Assisting the Treatment of Mild—to-moderate Persistent Chronic Bronchial Asthma in the Elderly / 上海针灸杂志

Objective To observe the clinical efficacy of wheat-sized moxibustion in assisting the treatment of mild—to-moderate persistent chronic bronchial asthma in the elderly with Salmeterol xinafoate and fluticasone propionate aerosol. Method Eighty-four old patients with mild—to-moderate persistent chronic bronchial asthma were randomized into an observation group and a control group by using the random number table, 42 each. The control group was given Salmeterol xinafoate and fluticasone propionate aerosol, 1 inhalation each time, twice a day;the observation group was additionally given wheat-sized moxibustion by selecting Pishu (BL20), Feishu (BL13) and Geshu (BL17), twice a week. The two groups were both treated for 2 months. Before and after the intervention, Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), and pulmonary function parameters [peak expiratory flow (PEF), forced expiratory volume in one second (FEV1), and forced vital capacity (FVC)] were observed, and the clinical efficacies were compared. Result The total effective rate was 92.9% in the observation group versus 78.6% in the control group, and the difference was statistically significant (P<0.05); the ACT and AQLQ scores, as well as PEF, FEV1 and FVC were significantly increased after the intervention in both groups (P<0.05); after the treatment, the improvement in the observation group was significantly superior to that in the control group (P<0.05). Conclusion Wheat-sized moxibustion is effective in assisting the treatment of mild-to-moderate persistent chronic bronchial asthma in the elderly with Salmeterol xinafoate and fluticasone propionate aerosol. It can effectively controlasthma and enhance the quality of life.

Asthma Control in Hospital Tengku Ampuan Afzan, Kuantan, Malaysia: A Cross-sectional Study

Various initiatives and medications have been introduced to achieve better control of bronchial asthma. However total control according to Global Initiative for Asthma (GINA) remains elusive even at tertiary referral hospitals. Our study is to determine the level of asthma control (according to GINA 2009), Asthma Control Test (ACT) scores and the types of medications used among patients with bronchial asthma in a large tertiary hospital. Methods: A cross-sectional study of all patients with bronchial asthma who attended the Chest Clinic at Hospital Tengku Ampuan Afzan (HTAA) from 2009 to 2011. Patient demographics, self-administered ACT scores, GINA-defined level of asthma control and medications were documented. Results: 208 patients were recruited. There were 23.2%, 46.3% and 30.5% of patients with controlled, partly controlled and uncontrolled asthma respectively. The median ACT scores was 19 [inter quartile range (IQR) 6]. The most frequently used preventer therapy was inhaled long-acting β-agonist/corticosteroids (LABA/ICS) fixed-dose combination (61.7%), and 9.6% were not on preventer therapy. 75% of patients with controlled asthma were on LABA/ICS compared to 58.5% of the partly controlled and uncontrolled groups (p=0.039). Conclusion: The majority of the asthmatic patients attending the Chest Clinic at HTAA did not have GINA-defined controlled asthma. Patients with higher ACT scores had better control of asthma. There were more patients with controlled asthma who were on LABA/ ICS combination.

Clinical Factors Affecting Discrepant Correlation Between Asthma Control Test Score and Pulmonary Function

The Asthma Control Test (ACT) score is widely used in asthma clinics, particularly with the recent emphasis on achievement and maintenance of optimal asthma control. However, this self-assessment score does not always correspond with lung function parameters, leading to uncertainty about each patient's control status; therefore, we investigated the clinical characteristics that are associated with discrepant correlation between the ACT score and pulmonary function. The 252 adult asthmatic subjects were divided into 5 groups according to their changes in FEV1% predicted values and ACT scores between 2 consecutive visits three months apart. The data were retrospectively reviewed and several clinical variables were compared. Elderly, non-eosinophilic, non-atopic asthma patients were more likely to show paradoxical changes of pulmonary function and ACT score. Female patients were prone to report exaggerated changes of ACT score compared with baseline lung function and changes in FEV1 levels. This group was using more medications for rhinosinusitis. Male patients seemed less sensitive to changes in lung function. From these findings, we conclude that when assessing asthma control status, physicians should carefully consider patient age, gender, atopy status, blood eosinophil levels, and comorbidities along with their ACT scores and pulmonary function test results.

Assessment of control of bronchial asthma in children using Childhood Asthma Control Test.

Background. The use of Childhood Asthma Control Test (C-ACT) has been advised for monitoring asthma control by the Global Initiative for Asthma (GINA) guidelines. Objective. To validate the tool C-ACT for the assessment of control of asthma and to examine the correlation between C-ACT score and lung function assessed by forced expiratory volume in one second (FEV1). Methods. This was a prospective observational study conducted between January 2010 to January 2011. Children diagnosed to have bronchial asthma and aged 5 to 14 years, were enrolled in the study. Asthma severity and control status were classified according to the National Asthma Education and Prevention Programme (NAEPP) and GINA guidelines, respectively. Patients were followed-up at three and six months and C-ACT and spirometric measurements were obtained. Results. Significant positive correlations were found between C-ACT score and FEV1 at enrollment (r=0.772) (p<0.001), three months (r=0.815) (p<0.001) and at six months follow-up (r=0.908) (p<0.001). Baseline C-ACT score was useful for predicting the levels of control of asthma upto three months (0.004), but not at six months follow-up (0.787). A cut-off C-ACT value of >19 had a sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) 98.5%, 89.1%, 94.9%, 96.6%, 0.717, respectively for the control of asthma. Conclusion. C-ACT is a simple and feasible tool to assess and predict the levels of control in children with bronchial asthma upto three months.

Control levels among asthmatic patients attending asthma clinic at Eskan PHC center and general clinic at Kakiah PHC center, Makkah Al - Mukarramah, Saudi Arabia.

Background: Bronchial asthma is one of the most common chronic diseases in Saudi Arabia, affecting more than 2 million Saudis. Poor knowledge, fear of use of new drugs, and lack of awareness of the importance of control of the disease are common among primary care physicians caring for asthma patients in the Kingdom of Saudi Arabia. Aims & Objective: To estimate the difference in control levels (controlled, partially controlled, and uncontrolled) among asthmatic patients in Eskan and Kakiah PHC centers, in Makkah Al-Mukarramah, October, 2011. As well as to determine pertinent factors associated with control of bronchial asthma. Material and Methods: A Cross-sectional analytic study included all asthmatic patients attended asthma clinic at Eskan PHC center, and equal number of asthmatic patients attended general clinics at Kakiah PHC center, Makkah Al-Mukarramah during the study period (October, 2011). Both groups were asked to fill in a self-administered questionnaire to assess their symptoms and asthma attacks by using the Asthma Control Test (ACT). Data were collected by questionnaire consists of three parts: Demographic data (six items), associated factors (six items) and Asthma Control Test (valid in Arabic version); Adult ACT (five items) and Child ACT (seven items). Results: The study included 100 asthmatic patients (50 were recruited from Kakiah PHCC and 50 were recruited from Eskan PHCC). Slightly more than half of them were over 12 years old, 28 (56%), and 22 (44%) were 12 years old or less. More than half, 27 (54%), of the asthmatic patients recruited from Eskan PHCC compared to 17 (34%) of those recruited from Kakiah PHCC, were controlled. This difference was statistically significant (P=0.035). The difference between bronchial asthma control between Eskan and Kakiah PHCC was statistically significant among adults, while it was not statistically significant among children. Females were found to have significantly better control compared to males. Conclusion: Level of control of bronchial asthma was significantly better among patients attended asthma clinic than those attended general clinic, and females were found to have significantly better control compared to males.

The Impact of Asthma Control on Salivary Cortisol Level in Adult Asthmatics

Asthma is a chronic disease causing psychological stress which leads to the activation of hypothalamus-pituitary-adrenal axis. The purpose of this study is to compare morning salivary cortisol levels in persistent asthma patients according to their disease severities and control status. Total 206 adult asthma patients were recruited from four university hospitals. Spirometry, questionnaire of Asthma Quality of Life (AQOL) and Asthma Control Test (ACT) were completed, and saliva samples were collected prospectively to measure morning cortisol level. The mean patient age was 56.5+/-15.3 years with mean asthma duration of 9.1+/-11.1 years. Sixty five patents (31.6%) were classified as mild persistent asthma, and 141 patients (68.4%) were classified as moderate persistent asthma according to the Expert Panel Report 3. The mean predicted FEV1 was 88.8%+/-18.4%, and the methacholine PC20 was 9.6+/-8.5 mg/mL in all study population. The mean ACT score for all patients was 19.9+/-3.6, and there were 71 (34.5%) patients in poorly controlled and 135 (65.5%) in well controlled asthma. The poorly controlled asthma patients were characterized by significantly lower FEV1 (84.6%+/-17.6% vs 91.1%+/-18.5%, P=0.018), lower AQOL scores (46.0+/-13.9 vs 73.8+/-26.3, P<0.001), and lower salivary cortisol levels (0.14+/-0.08 vs 0.18+/-0.11 microg/dL, P=0.04) compared to well controlled asthma. The ACT score was significantly related to salivary cortisol levels (P=0.034) after adjusting for age. There was no significant difference in salivary cortisol levels (0.17+/-0.12 vs 0.16+/-0.08, P=0.725) when analyzed according to the dose of used corticosteroid and lung function. Asthma control status affects morning salivary cortisol level. Measuring the morning salivary cortisol level might be a simple and new way to assess asthma control status.

The clinical application value of serum high sensitivity C-reactive protein for the acute exacerbation bronchial asthma patients / 中国医师进修杂志

Objective To study the correlation between the level of serum high sensitivity C-reactive protein (hs-CRP) and induced sputum cell counts,pulmonary function and asthma control test (ACT) in order to investigate the clinical application value of serum hs-CRP for the acute exacerbation bronchial asthma patients.Methods Thirty acute exacerbation bronchial asthma patients were collected as asthma group,14 healthy people during the same period were collected as control group.The fasting serum hs-CRP was examined in control group and before and after treatment of 5-7 d in asthma group.The induced sputum was obtained by ultrasonic atomizer 4.5％ sodium chloride,and the percentage of eosinophils (EOS％),neutrophil,macrophages,lymphocytes was calculated.The pulmonary function index was determined in control group and before and after treatment in asthma group.ACT score was performed in asthma group.The correlation between the serum hs-CRP and induced sputum differential leukocyte count,the pulmonary function index and ACT score was analyzed by Spearman correlation analysis.The effect of the serum hs-CRP and induced sputum EOS％ on inflammatory response of acute exacerbation bronchial asthma was evaluated by receiver operating characteristic (ROC) curve analysis.Results Two cases were excluded in asthma group.The serum hs-CRP before and after treatment in asthma group was higher than that in control group[4.18(2.12-11.12) and 3.40(2.02-8.91) mg/L vs.1.48(1.03-4.81) mg/L,H =18.939,P＜ 0.01].The serum hs-CRP before treatment was higher than that after treatment in asthma group (P ＜ 0.01).In asthma group,the serum hs-CRP had positive relationship with induced sputum EOS％ (r =0.849,P =0.000).There were negative correlations between the serum hs-CRP and the pulmonary function index such as one second forced expiratory volume percent predicted,one second forced expiratory volume occupied vital capacity ratio,maximum mid-expiratory flow percentage of predicted (r =-0.617,-0.559,-0.398,respectively,P =0.000,0.002,0.036,respectively).It was also found that the serum hs-CRP and ACT score had the remarkable Spearman linear correlation (r =-0.511,P =0.005).The area under the ROC curve of the serum hs-CRP was 0.713 (P =0.003).Conclusions There are significant correlations between the serum hs-CRP and induced sputum EOS％,pulmonary function,ACT score in the acute exacerbation bronchial asthma patients.It is found that hs-CRP could be considered as one of the potential marker to evaluate the systemic inflammation level of bronchial asthma.

Evaluation of Atorvastatin for the Treatment of Patients With Asthma: A Double-Blind Randomized Clinical Trial

PURPOSE: Statins are known as cholesterol-lowering agents, but have been suggested for the treatment of asthma because of their anti-inflammatory effects. In this study, the potential therapeutic effects of atorvastatin were investigated in asthmatic patients. METHODS: A total of 62 patients with persistent mild to moderate asthma who presented at asthma clinics of Arak University of Medical Sciences were recruited in a double-blind randomized clinical trial. The asthma clinical control score was assessed based on the standardized Asthma Control Test. Lung volume, i.e., percentage of forced expiratory volume in one second (FEV1%) and percentage of forced vital capacity (FVC%), and peripheral blood eosinophils were also measured. The intervention group was treated with atorvastatin 40 mg per day for 8 weeks, while the control group received a placebo. Asthma controller treatments were not changed. At the beginning and end of the study, serum cholesterol and triglyceride levels were measured to evaluate adherence of the patients to the treatment. RESULTS: The asthma control score did not significantly differ between the intervention and control groups (P=0.06). Difference in FEV1%, FVC%, and blood eosinophil count between the intervention and control groups were not statistically significant (P>0.05). The differences in post-treatment cholesterol and low-density lipoprotein cholesterol levels were significant (P<0.05). CONCLUSIONS: Our study shows that atorvastatin is not effective in the treatment of persistent mild to moderate asthma.

Clinical research on the treatment of moderate bronchial asthma with inhaled inactivated-mycobacterium phlei / 中华急诊医学杂志

Objective To introduce inhaled inactivated-mycobacterium phlei on prevention and treatment of moderate bronchial asthma to observe the clinical effect. Method This study was a prospective and controlled study. The patients diagnosed with asthma in our out-patient from March 2009 to December 2010 were collected, who met the following conditions were included in the study: age≥ 14 years; met the criteria of moderate chronic persistent bronchial asthma in Global Initiative for Asthma (GINA) in 2008; suspended receiving systemic corticosteroids, Montelukast, ketotifen and other anti-inflammatory and anti-allergic drugs in one month; no significant respiratory tract infections; and other serious illnesses or abnormalities known.A total of 100 patients with asthma were selected, including 37 males and 63 females, age (32.11 ± 12.95 )years. The patients were randomly(random number) divided into two groups: A group(treatment group; 16males and 34 females, age 33.56 ± 14.23 years) and B group (control group; 21 males and 29 females,age 30.66 ± 11.50 years); 50 in each group. No significant difference was noted between the two groups on age and gender composition. The patients in A group were treated with inhaled inactivated-mycobacterium phlei F. U. 36 Injection 1.72 μg/mL × 2 that adding 3 mL normal saline, once a day for 5 days. The patients in B group were treated with salmeterol xinafoate and fluticasone propionate powder for inhalation (50/100 μg), twice daily for sustainable use. The patients in the two groups were observed for one month. During this course, the patients in the two groups could inhale the salbutamol sulphate aerosol as need to relieve symptoms. And the number of using was recorded. Pulmonary function test and asthma provocative test were carried out on the Day O, 6 and 31. ACT scores were measured before and after the treatment. Results On Day 6 and 31 after treatment, the negative conversion rates of asthma provocative test of the patients in A group were 82% and 78% respectively, B group were 84% and 90% respectively. Provocative test of the patients in the two groups were negative conversion significantly before and after treatment. There was no significant difference between the two groups by chi-square test (P ＞ 0. 05 ). Completely random designed data was analyzed by analysis of variance. The analysis showed that the accumulated doses of methacholine of the patients in the two group increased significantly ( P ＜ 0. 05 ), but no difference between the two groups.There was a improvement trend on forced expiratory volume in one second( FEV1 )of the patients in A group after treatment, but no difference. FEV1 of the patients in B group increased significantly higher ( P ＜0.05), which was significantly higher than A group on the 31th day (P ＜0. 05); Peak expiratory flow (PEF) of the patients in the two group increased significantly on Day 6 and 31 after treatment (P ＜0.05 ).On Day 31, B group was significantly higher than A group ( P ＜ 0. 05 ); Scores of asthma control test (ACT)of the patients in the two group were significantly increased, and the number of using of salbutamol sulfate aerosol was significantly reduced (P ＜0.01 ). B group was obvious than group A (P ＜0.05 ). During treatment, there were only two adverse reaction cases of transient low fever; most obvious was on the third day.Conclusions Inhaled inactivated-mycobacterium phlei would inhibit the airway hyperresponsiveness of the patients with moderate bronchial asthma in short time, improve the symptoms, reduce the acute exacerbation, and reduce the use of rescue medication, which has the roles of prevention and treatment of moderate asthma in a certain period of time.

Relevance of Exhaled Nitric Oxide Levels to Asthma Control Test Scores and Spirometry Values in Children with Atopic Asthma / 소아알레르기및호흡기학회지

PURPOSE: Fractional exhaled nitric oxide (FeNO) has been proposed as a tool for assessing airway inflammation in patients with atopic asthma. We evaluated the relationship between FeNO with asthma control test (ACT) scores and spirometry values in children with atopic asthma. METHODS: One hundred twenty-six children with atopic asthma, 8-16 years of age, were included in the study. None of the participants received regular controller therapy for at least 4 weeks before the study. The ACT (for children >12 years of age) or the Childhood Asthma Control Test (C-ACT; for children between the ages of 8 and 11 years of age), FeNO measurements and pulmonary function tests were performed. RESULTS: The geometric mean of the FeNO in children with atopic asthma (16.1 parts per billion [ppb]; 95% CI, 14.5-17.8 ppb) was significantly higher than that healthy controls (7.5 ppb; 95% CI, 7.0-8.1 ppb; P 20 in 82% of enrolled patients and correlated with the %FEV1, FEV1/FVC, and %FEF25-75. However, FeNO was not related to %FEV1, FEV1/FVC, %FEF25-75, and scores for asthma controls. FeNO levels in asthmatic children were not significantly different with respect to age, gender, BMI, and tobacco exposure. CONCLUSION: FeNO was not related to the spirometry values and scores for asthma control. Measurement of FeNO may be a complementary tool in the assessment of asthma control.