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OBJECTIVE： To study the effects of ADRB2 （rs1042713） gene polymorphism on therapeutic efficacy of anticholinergic drug in the treatment for refractory asthma pediatric patients. METHODS： 171 children with refractory asthma were selected from outpatient department of Kunming Children’s Hospital during Nov. 2016 to Jul. 2019. The distribution of ADRB2 （rs1042713） genotype， the clinical efficacy [asthma control test （C-ACT） score， FEV1， FVC， PEF， maximal mid-expiratory flow （MMEF）] of anticholinergic drug were analyzed statistically； the response of different genotypes to the use of anticholinergic drug were also analyzed statistically. RESULTS： 148 of 171 refractory asthmatics pediatric patients were administered anticholinergic drug， among them 50 of the 71 AA genotype and 36 of the 77 GA genotype responded to anticholinergic drug treatment. Statistical analysis showed that 71 children with AA refractory asthma had improved C-ACT score， FEV1， FVC， PEF and MMEF， there was statistical significance， compared with GA genotype （P＜0.05）； the response rate of the AA genotype to anticholinergic drugs was 2.71 times that of the GA genotype [OR＝2.71， 95％CI （1.38， 5.34）， P＝0.005]. CONCLUSIONS： The detection of ADRB2 （rs1042713） gene polymorphism has some guiding significance in the treatment of refractory asthma with anticholinergic drugs， and the response of AA genotype is better.
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OBJECTIVE: To study the value of ADRB2, GLCCI1, FCER2 gene detection in individualized medication of children with refractory asthma.METHODS: Clinical pharmacists participated in therapy for 2 cases of refractory asthma, and comprehensively analyzed risk factors as its pathogenic factors (allergens and pathogens of respiratory infections), lung function indexes and family history. It was suggested to conduct anti-asthmatic drugs gene [p2-adrenergic receptor (ADRB2), glucocorticoid induced transcriptional 1 gene (GLCCI1), low affinity IgE receptor (FCER2)] testing. According to detection results, the suggestions were put forward such as increasing the dose of Glucocorticoid for inhalation, stopping β2 receptor agonist, additionally using anticholinergic drug. RESULTS: The clinical physicians adopted the suggestions of clinical pharmacists. After optimizing refractory asthma therapy plan according to the results of gene testing and clinical factors, 2 patients were stable and the number of seizures decreased significanthy. CONCLUSIONS: Gene test can provide evidence for the formulation of individualized therapy in asthma children.
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Aim] To summarize and introduce the clinical experience of Chang Qing in the treatment of refractory asthma. [Method] To analyze the clinical experience and academic views of Chang Qing in the treatment of refractory asthma from the perspective of etiology and pathogenesis; and to discuss his basic prescription compatibility and flexible drug-applying characteristics. [Result] According to Chang Qing's clinical experience, while addressing the symptoms, treating the root is badly needed. He insists that in the period of acute exacerbation the adjustment of traditional Chinese medicine dosage should be used to rapidly bring the asthma under control until the symptoms disappear or obviously ease, then nourishing spleen and kidney to reduce the relapse of asthma. [Conclusion] In the aspect of treating the refractory asthma, Chang Qing has got rich clinical experience and effective. methods to relieve the asthma,his clinical dialectic thinking and the originality of prescription are greatly worth learning.
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Objective To investigate the clinical outcomes of flupenthixol melitracen on refractory asthma with anxiety and/or depression.Methods 105 patients with refractory asthma,who were given asthma controlled test (ACT) and comprehensive hospital anxiety and depression scale (HAD)test,were randomly classified into control group and treatment group,the former used recommended classical drugs in the consensus,Salmeterol Xinafoate and Fluticasone Propionate and Montelukast;while the latter used above therapy combining flupentixol melitrace.HAD score,ACT score and pulmonary function were applied to assess therapeutic effect.Results In 105 cases of refractory asthma patients,75 patients were complicated with anxiety and/or depression,with prevalence of 71.42％.With the alleviation of anxiety and/or depression,the degree of asthma controlled was improved.After treatment,HAD score of the treatment group was lower that of control group((10.67±2.32) scores vs (11.94±3.02) scores,t=2.06,P＜0.05),ACT score in treatment group was much higher than that of control group((14.54± 3.14) scores vs (11.25±3.06)scores,t=4.59,P＜0.01),there were statistical significance in FEV1％ pre between two groups ((55.29±5.72) vs (43.36±7.13),t=8.02,P＜0.01).Conclusion Antidepressant treatment can alleviate anxiety and/or depression,improve the clinical curative effect of refractory asthma and help to improve lung function.
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Objective To discuss the effect and feasibility of BiPAP in refractory asthma patients. Methods A total of 15 coses of refractory bronchial asthma admitted by our hospital during Feb 2003 to May 2006 were treated by BiPAP in addition to medical therapy。 The symptoms、signs and the arterial blood gases were observed and analyzed。Results Among 15 patients,2 gave up treatment,13 patients were successfully treated with the BiPAP therapy。There were significant improvement of PaCO2、PaO2、pH and respiratory rate ,heart rate after 2h BiPAP。Conclusions Ventilation in BiPAP is an effective method for refractory asthma ,which can save the patients life and decrease the complications.