Clinical Observation Of 83 Patients With Moderate To Severe Chronic Persistent Bronchial Asthma

BackgroundAsthma is a heterogeneous disease characterized by varying degrees of airway spasm,airway hyperresponsiveness,mucus secretion,and chronic inflammation.The chronic inflammation is associated with airway hyperresponsiveness.It usually has reversible airflow limitation and can cause recurrent wheezing,shortness of breath,chest tightness or cough and other symptoms,which often occured or exacerbated at night or early in the morning,but most of the patients can be relieved by themselves or after treatment.Asthma affects about 300 millions of people all of the world,and the number of death toll is as high as 250 thousand per year.When the asthma was effectively controlled,only a little of the patients appeared acute asthma attack and severe asthma attack is especially rare.Global asthma burden data show that although the cost of controlling asthma seems to be slightly higher,but non-standard treatment can lead recurrent asthma and treatmen costs will be higher.The 2016 edition of the global initiative for asthma(Global initiative for asthma,GINA),recommended ICS/LABA combination for long-term treatment to moderate to severe persistent of patients with asthma.ICS and LABA have synergistic effect and anti-inflammatory and antiasthmatic effects greatly enhanced.The curative effect is equivalent to doubling dose of ICS and can increase the compliance of patients andreduce the the adverse reaction of ICS of high dose.Besides,low dose of budesonide/formoterol can be used as asthma relieving drugs.The ICS/LABA combination often used in our clinical practice is different specifications of budesonide/formoterol and salmeterol/fluticasone propionate powder for inhalation and beclomethasone/formoterol aerosol.Leukotriene receptor antagonists(LTRA),including cysteinyl leukotriene modulators and 5-lipoxygenase inhibitors,is the only kind of drug except ICS that can be used alone as long-acting control drugs.It can be used as an alternative treatment for mild asthma or a combination of moderate to severe asthma.The main LTRA we used is cysteinyl leukotriene receptor antagonist at present in China.LTRA can reduce asthma symptoms,improve lung function,delay and reduce the deterioration of asthma,but its anti-inflammatory effect is not as powerful as ICS.Inhaled anticholinergic drugs including short-acting anticholinergics(SAMA)such as ipratropium bromide and long-acting anticholinergics(LAMA)such as tiotropium bromide have the effect of Bronchial dilation,but compared with?2-agonists,its effect is weaker and the onset time is slower.Short-acting anticholinergic drugs can be administered by aerosol and atomization solutions,while long-acting anticholinergics are administered primarily through dry powders and aerosols.Anticholinergic drugs and ?2-agonists have a complementary role in the application.However,early pregnancy women,glaucoma patients and patients with prostatic hypertrophy should be careful with such drugs.For moderate to severe chronic persistent asthma,the combination of medication have got more and more attention,and achieved the desired effect in the clinical.In some countries,even the combination therapy has been included in the first-line treatment program.This study followed randomized,parallel,controlled,and the open principle to observe the clinical efficacy of budesonide/formoterol combined with montelukast sodium,budesonide/formoterol combined with tiotropium bromide and inhaled budesonide for chronic persistent asthma after 1 month and 3 months,providing a new idea for the treatment of moderate to severe chronic persistent asthma.ObjectiveTo evaluate the clinical effect of the combination of symbicort and montelukast sodium,the combination of symbicort and tiotropium bromide and simple inhalation of symbicort in the treatment of moderate to severe asthma.MethodsEighty-three patients with moderate to severe chronic asthma were selected from the First Affiliated Hospital of Zhengzhou University from March 2015 to March2016.They were randomly divided into three groups: group A,group B and group C.The group of A(n=28)were treated with symbicort combined with montelukast,the group of B(n=28)were treated with symbicort combined with tiotropium,the group of B(n=27)were treated with symbicort only.The clinical effects among the three groups were compared after 1 month and 3months treatment.Results1.There were no significant differences among the three groups in age,gender,course of disease at the beginning of the study(P>0.05).2.There were significant differences among the three groups in asthma control after treatment than before(P<0.05).3.There were significant differences among the three groups in lung function after treatment than before(P<0.05).There was no significant difference between the two groups of A and B(P > 0.05)after treatment.There were significant differences between the groups of A and C,B and C.4.There were no significant changes in peripheral venous blood eosinophils(Eos)among the three groups after 1-month treatment(P>0.05)than before and there were significant differences among the three groups after 3 months treatment.Conclusions1.Symbicort tuibuhaler combined with montelukast and Symbicort tiotropium combined with Tiolropium have better effects in asthma control and ameliorating pulmonary function than Symbicort tuibuhaler only.2.Symbicort tuibuhaler combined with montelukast and Symbicort tiotropium combined with Tiolropium have similar effects.