| BACKGROUNDBronchus asthma is a chronic allergic airway inflammation which includes inflammatory cells,acute bronchoconstriction resulted in medium and airway structure interactions between cells,edema of airway wall,increase of mucus secreted,obstruction and high reactivity of the airway caused by remodeling.Corticosteroids are the strongest anti-inflammatory drugs at present,it can inhibit the airway inflammation,achieve the effect of long-term asthma control.There is no drugs can be replaced its clinical effect.Global Initiative for Asthma(GINA)explicitly pointed out that duration to the daily law should be inhaled corticosteroids as long-term control method,and used hierarchical treatment according to the illness severity for asthma patient.Long time use of corticosteroids,can effectively control hyperresponsiveness caused by chronic airway inflammation,reduce the number of asthma attacks,to achieve more conducive asthma control.The traditional administration ways are oral and venous,it can produce adverse reaction such as osteoporosis,high blood pressure,diabetes,HPA suppression,obesity,cataracts,glaucoma,skin thinning lead to skin grain,stasis and muscle weakness which limits the application in preventing and controlling asthma.Inhaled corticosteroids(ICS)get the medicine by breathing,it can decrease side effects of the whole body and direct effect in respiratory target organ,which required little dosage.Therefore,inhaled corticosteroids have become the first choice of long-term treatment of persistent asthma.Chronic airway inflammation is an important feature of the bronchial asthma,mainly shows infiltrating in eosinophil,lymphocytes and mast cells etc.Airway inflammatory reaction is the result of interaction inflammatory cytokines medium released by local infiltrating inflammatory cells.Inflammatory mediators play a role in asthma attacks,aggravation of the illness and the typical pathological changes.Interleukin-4(IL-4),Interleukin-5(IL-5)mainly come from Th2 cells,direct stimulation synthesis of IgE.Eosinophils cationic protein(ECP)is the main sign of eosinophils activation in asthma development,which involved the airway responsieness formation in common.So directly measure the serum IL-4,IL-5 and ECP level have important meaning for evaluation and treatment of asthma disease.Along with the development of medical and health services,hospital pharmacy experienced the traditional stage which centered for drug supply,clinical pharmacy stage mainly participated in clinical drug therapy practice to promote the rational use of drugs and the higher levels of pharmaceutical service stage which taking patients for the center,emphasis on improving the quality of life in patients with phase.Service functions in department of pharmacy are changed in the center of drugs to patient.Guide patients and help doctors in the rational use of drugs are gradually becoming the main content of the pharmacist.The core work of clinical pharmacy is rational use of drugs,the mission of clinical pharmacist is to provide pharmacy services.Hospital pharmacy in the prevention,medical,health care and rehabilitation integration work of disease are becoming more and more important.Clinical pharmacists play a pivotal role in promoting rational use of drug,improving the quality of medical treatment.Serve patients for the purpose of whole course pharmacy service mode has become the main development direction of hospital pharmacy.OBJECTIVEIn the conditions of limited health resources,whether there is a treatment to lower the cost for the same or more benefit is worth exploring.Therefore,this study compared the effect before and after treatment in asthma patients and evaluated index by drug costs-effect,validate significance of different ways of corticosteroids.For clinical workers,this way can improve rational use of medicines,reduce the cost of treatment by experience.At the same time,we can explore the pharmaceutical care mode of clinical pharmacists in asthma patients,discover problems of medicine treatment timely in order to avoid serious consequence and promote clinical rational use of drug.We summarized in the following three points:1.System evaluated the clinical curative effect for different ways of corticosteroids in the treatment of asthma patients.2.Calculated and analysed the ratio of cost-effect respectively using two kinds of treatment plan in asthma patients.3.Explored pharmaceutical care mode of the clinical pharmacists in patients with asthma.RESEARCH METHODSAll cases were collected from March 2010 to March 2012 with respiratory in hospital,which were comprehensive analysis and identified according to the 2008 years the bronchus asthma control guide of clinical manifestations,risk factors exposure,signs and laboratory examination material.Whom clinical manifestation were not typical,should at least have the following test for one positive:bronchial tests or sports stimulate is positive;bronchodilation test positive and FEV,quartile increase?12%,FEV1 increase quartile absolute value of 200 ml;Peak expiratory flow(PEF)days quartile mutation rate?20%.Clinical expression was refered to the symptom suddenly happen or worse of breath shortness,cough,bosom frowsty,often had difficulties in breathing,characteristics in expiratory flow reducing,often because of contacting allergens irritant or improper treatment etc.The research process was divided into two stages:initial treatment period and hormone treatment phase.Patients with asthma in the initial treatment aerosolized beta 2 agonist rapidly(salbutamol solution 1 ml with physiological saline,dilute to 5 ml),every 20 minutes within the first hour(repeat 3 times),until blood oxygen saturation quartile?90%,and combinated anti-asthmatic drugs(such as theophylline,anticholinergic),after initial treatment was the hormone treatment period,patients were numbered according to clinical sequence,then randomly divided into two groups.The ICS group inhaled budesonide(BUD)suspension 2 mg,three times a day by oxygen jet atomization(Pumicort,Astrazeneca).Systemic corticosteroids(SCS)group intravenous drip methylprednisolone(Sou-Medrol,American Pfizer)80 mg/d by seven days,and than take tables of methylprednisolone(Medrol,American Pfizer)32 mg,qd by seven days with sequential-therapy.Both ICS and SCS groups were treatment for 2 weeks.Other anti-asthmatic drugs could be used according to the needs in hormone therapy periods,if it was necessary,antibiotics,oxygen,etc could also be used.The two groups of ICS and SCS was compared before and after treatment for serum and induced sputum interleukin 4(IL-4),interleukin 5(IL-5),eosinophils cationic protein(ECP)content and 24-hour urinary free cortisol(24 h-UFC),than compared with the total costs and medical treatment cost-effect evaluation of the two groups patients.In this period,pharmacists worked clinical and participated in clinical rounds,case discussions and medicine calendar writing,taked patients for drug education,such as to provide patients how to use all kinds of aerosol device.Than discovered,monitored adverse drug reactions(ADR),evaluated the significance for different ways of corticosteroids in asthma treatment.This could gather experience in rational use of drugs,reduce the cost of treatment for clinical worker.Statistics processing,data were showed mean ? standard deviation(x±s).For data of each index before and after treatment,we could use matching t-test within groups,independent sample t-test compared with two groups;After treatment,the comparison between the groups use covariance analysis;Rate between the two groups compares Chi-square test.All the data were analysed by statistical software SPSS13.0.For P<0.05 is significant difference,P<0.001 is very significant difference.RESULTSCompared with treatment,after 2 weeks curing,content of IL-4,IL-5 and ECP in peripheral blood were reduced obviously,which had very significant difference(P<0.001).The induction phlegm IL-4,IL-5,ECP content after treatment was decreased,which had very significant difference(P<0.001).There was no significant difference between the two groups of patients after treatment by IL-4,IL-5 and ECP content.These results demonstrated that ICS and SCS can effectively restrain the airway inflammation,and there was no significant differences compared with the two groups.The study also found that after 2 weeks therapy,level of 24-hour urinary free cortisol decreased both in ICS and SCS groups.Compared before and after treatment,24h-UFC in ICS group was significantly decreased(P=0.030).Compared before and after treatment,24h-UFC in SCS group was very significantly decreased(P<0.001).There were very significantly difference(P<0.001)after treatment with SCS and ICS group.All of the date show that compared to SCS,short-term ICS treatment had less effect to HPA axis.This test was designed with the forward-looking test,which could reflect the real health service costs.But this clinical trials only designed for 2 weeks,other medical costs and indirect costs may be remoted,so we thought the cost of this research reflected the real data of the treatment.Compared with SCS group,direct cost of ICS group increasedY 51.45,cost-effect for ICS group was 68.21,SCS group was 70.59.Incremental cost-effect reveal that based on SCS group,incremental cost-effect is 13.83.Finally,this paper used 3 typical clinical cases in respiratory medicine department as an example,analysed the work of clinical pharmacists and the contribution of clinical pharmacists in clinical drug therapy,Thus reflected the content in clinical practice which need clinical pharmacists to grasp,guided the training mode preliminary construction of clinical pharmacy in China from the practice.Case analysis showed that in clinical drug therapy,clinical pharmacists directly care patients,fully pay attention to prevent and intervene the patients with medication guided and adverse drug reactions,fully involved in the regimen and drug configuration and application for method instruction,etc.In order to ensure clinical pharmacy practice can work smoothly and patient can get effective,reasonable,economic treatment,clinical pharmacists must master the commonly used of medicine in clinical drug information,medical knowledge of common diseases,clinical significance of auxiliary examination index and drug economics etc.CONCLUSIONInhaled corticosteroids in large doses had similar role with systemic corticosteroids in the decrease of IL-4,IL-5 and ECP.ICS had the same curative effect with SCS in asthma control and symptoms improving.Two treatment scheme had a similar role in anti-airway inflammation.ICS treatment of asthma had smaller HPA suppression effect and safety,more.reasonable economy,it could reduce the dangerous side effects of long-term and high-dose brought by SCS.As a professional pharmaceutical personnel,we must had a solid pharmaceutical knowledge and it is the implementation of the pharmaceutical care premise.As a clinical pharmacist,we should timely,accurately and completely master the pharmaceutical knowledge and information.We should also have good medical personnel communication skills,with positive attitude in-depth participation in clinical drug therapy,quickly searched related disease treatment guidelines and other information to help the doctors in treatment implementation.In the treatment,clinical pharmacist should develop detailed pharmaceutical care plan to patients,which from safety,efficacy,compliance three aspects,fully involved in the allocation guidance of doctors and nurses formulated regimen of drugs.Clinical pharmacists only deeply in clinical,we could understand the illness and patients with medical treatment and adverse reaction,played professional expertise to help solve the problems in the treatment of disease.At the same time,we let the medical staff know the status of clinical pharmacists in drug team treatment,build the solid foundation of clinical pharmacy for the smooth development. |
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