| BackgroundBrochial asthma(BA)is a specific or non specific excessively irritant reaction due to the reversible airway obstruction of the respiratory system and the excessive secretion of sputum.Bronchial asthma is a chronic inflammatory disease of the respiratory tract.The patients suffering from this disease are often characterized by recurrent episodes of wheezing,respiratory distress,chest tightness and coughing at night.Bronchial asthma is very common in pediatric clinical,the disease is seasonal and occurs in summer and autumn.The incidence rate is 0.11%~2.03%.In recent years,the incidence of bronchial asthma in children in China increased significantly.Children with asthma bronchial respiratory function was significantly worse than normal children,often manifested as chest tightness,shortness of breath,wheezing,lung widespread wheeze,cough and other symptoms,and the condition is easily repeated,if improper treatment or missed the best treatment time,condition may progress rapidly to pulmonary heart disease,emphysema,even endanger children life.Children with bronchial asthma are excepted from respiratory dysfunction,and a large number of inflammatory factors such as tumor necrosis factor(TNF),interleukin(IL)and interferon(interferon)can lead to airway inflammation and aggravate the disease.Budesonide Suspension for Inhalation is currently widely used in BA aerosol inhalation treatment of glucocorticoids,the drug can better play the role of local anti-inflammatory,and its curative effect is clear.However,little scavenging effects of these drugs on leukotrienes inflammatory mediators.Montelukast sodium is a typical leukotriene receptor antagonist,which can not only improve the lung function of asthmatic patients,but alsoplay an important role in anti inflammation and regulating immune function.At present,the literature reports on the combined application of montelukast and budesonide for treatment of bronchial asthma at home and abroad are relatively few,and most are discussed briefly the effectiveness and safety of the combination,there is still a lack of systematic research on the combination of airway inflammation in children with the influence of how to response.Montelukast Combined with budesonide on improving clinical symptoms in children with bronchial asthma and airway inflammation in assessing the effect of the purpose of this study is to,in order to further improve the level of clinical treatment in children with bronchial asthma.ObjectiveTo study the clinical significance of Montelukast Combined with budesonide on bronchial asthma in children,explore the oral administration of Montelukast Sodium Tablets combined budesonide inhalation therapy effect on bronchial asthma symptoms and airway inflammation,and to provide scientific basis for the clinical treatment of children with bronchial asthma.MethodsDuring the period from February 2014 to August 2016 in our hospital diagnosed and hospitalized 246 cases of bronchial asthma were treated as the research object,randomly divided into single treatment group(control group set up for a total of 124 cases)and combination group(the establishment of the observation group,a total of 122 cases).Two groups of children after admission were given oxygen,expectorant,cough,bronchiectasis and anti infection and other conventional treatment.On the basis of conventional treatment,the control group was given budesonide suspension inhalation treatment,while the observation group was given oral administration of Montelukast Sodium Tablets on the basis of the control group.Comparison of two groups of children hospitalized during the clinical treatment of the total efficiency.Before and after treatment were compared between the two groups of children with clinical symptoms(wheezing,dyspnea,wheezingdisappearance time and daytime symptom score),pulmonary function index [FVC(FVC),forced expiratory volume(FEV1),the forced expiratory volume in one second forced vital capacity(FEV1/FVC)].And serum inflammatory cytokines(interleukin [-4(IL-4),tumor necrosis factor alpha(TNF-α)] the changes.In addition,before and after treatment were compared to determine the level of nitric oxide(FeNO)of two groups of children with breath changes,and were detected by enzyme-linked immunosorbent assay in induced sputum were inflammatory factors [interleukin-8(IL-8)and interferon gamma(IFN-γ)]and eosinophil cationic protein(changes in the level of ECP).During the treatment,adverse drug reaction and close observation of children in two groups,and were followed up for 1 years to observe the number of children with asthma,a comprehensive evaluation system of the clinical effect of Montelukast Combined with budesonide in the treatment of children with bronchial asthma.Results1.Clinical baseline data.Before treatment,the control group and the baseline clinical data for patients in the observation group,as there were no significant gender,age,course of disease,asthma attacks,disease classification differences(P>0.05),comparative study of feasibility.2.Total effective rate of clinical treatment.During hospitalization,the total effective rate of the observation group was 94.26%(115/122),which was significantly higher than that of the control group(77.342%)(96/124),and the difference was statistically significant(P<0.05).3.Clinical symptoms.During the hospitalization of the patients in the observation group,wheezedisappeared time [(4.29±0.72)d],breathing difficulties disappear[(3.43±0.56)d],wheezing disappearance time [(2.55±0.37)d],were significantly shorter than the control group [(6.71±1.25)d],[(6.31± 0.99 d]),[(4.34 ±1.02)d],the difference was statistically significant(P<0.05);before treatment,there was no significant difference between the two groups of children with clinical symptoms(P >0.05),after treatment,theobservation group with daytime symptom scores [(0.92±0.04)%],[(nighttime symptom score 0.87±0.12)%],were significantly lower than the control group [(1.62±0.26)%],the night symptom score(1.96±0.53)[points],the difference was statistically significant(P<0.05).4.Lung function index.Before treatment,two groups of pulmonary function indexes(FVC,FEV1,FEV1/FVC)showed no significant difference(P>0.05),after treatment,two groups of children with pulmonary function were significantly improved(P<0.05),and the observation group with FVC[(3.97±0.34)L],FEV1[(2.73±0.29)L] FEV1/FVC[(79.22±5.41)detected were significantly better than the control group FVC[(2.82±0.56)L],FEV1[(2.25±0.34)L],FEV1/FVC[(71.26±7.38)detected the difference was statistically significant(P<0.05).5.Serum inflammatory factor levels.Before treatment,in the level of two groups of serum inflammatory cytokines(IL-4,TNF-α)there were no significant differences(P>0.05),after treatment,two groups of serum inflammatory factor levels were significantly improved(P<0.05),and the observation group with IL-4[(43.82±9.96)ng/L],TNF-α[(40.22 ±7.36)ng/L],were significantly better than the control group [(57.32±10.47)ng/L],[(76.37± 11.26)ng/L],the difference was statistically significant(P<0.05).6.FeNO level.Before treatment,FeNO levels were no difference between the two groups(P>0.05),after treatment with FeNO levels of two groups were significantly decreased(P<0.05),and the observation group with the level of FeNO [(30.32±2.16)ppb]was significantly lower than the control group [(65.46±7.12)ppb],the difference was statistically significant(P<0.05).7.Induced sputum inflammatory factor and the level of ECP.Before treatment,two groups of induced sputum supernatant IL-8,IFN-γ,ECP levels were not significantly different(P>0.05).after treatment,two groups of IL-8 and IFN-γin induced sputum supernatant and ECP levels were significantly decreased(P<0.05),and the observation group with IL-8[(72.88±13.09)ng/L],IFN-γ[(63.56±8.25)ng/L],ECP[(35.23±9.83)g/L],were significantly lower than the control group [(92.40±11.74)ng/L],[(41.76±6.33)ng/L],[(67.14±6.64)g/L],the difference was statistically significant(P<0.05).8.Follow up results.This group of children were followed up for 1 years,3 months,6 months and 12 months after treatment,the observation group the number of children with asthma [(2.37± 0.54)times],[(1.76±0.25)times],[(0.84± 0.06)times,were significantly less than the control group [(3.56± 1.03)times],[(2.62± 0.43)times],[(1.74±0.06)times,the difference was statistically significant(P<0.05).9.Adverse drug reactions.No serious adverse drug reactions and can be tolerated in children during the treatment,the observation group of nausea in 3 cases,1 cases had a rash,headache in 2 cases;the control group were nausea in 4 cases,2 cases had a rash,headache in 2 cases,the incidence of adverse reaction(observation group 4.92% vs.control group 6.45%)were compared,the difference was not statistically significant(P>0.05).ConclusionsMontelukast Combined with budesonide in the treatment of bronchial asthma in children can significantly improve the clinical efficacy,effectively control the clinical symptoms of asthma in children,improve the pulmonary function and promote its recovery,significantly reduce the number of airway inflammation and asthma attacks in children,not increase adverse drug reactions,combined use of drug safety.The sex is high,and it is worth promoting and using in the clinic. |
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