Exploratory The Establishment Of Improved Method In Bronchial Provocation Tests For Infants And The Clinical Application

PART 1 THE ESTABLISHMENT OF IMPROVED METHOD IN BRONCHIAL PROVOCATION TESTS FOR INFANTSBackground:At present, the lung function examination is the mainly objective basis in diagnosing and judging the curative effect of asthma and the cough variance asthma (CVA). But infants asthma and CVA clinical manifestation are complicated, even extremely atypical. The conventional lung functional examination only has the great value to diagnose and judge the condition for period of onset asthma, but it almost shows normal at the atypical asthma, CVA and the medication treatment period infants. So the value of the examination is limited.The bronchial provocation tests (BPT) is sensitive method to examine airway hyperresponsiveness (AHR). American Chest Science Association promulgated the BPT guide line in 1999. At present, the BPT clinical application has already been maturer in adult, the BPT in children has carried out only at several large-scale pediatric domestic hospital recent years, because it is very difficult to carry out, especially in infants. Because of the great requirement in clinic, infants BPT had been developing gradually in abroad. But there is no a public international standards at present, because the equipment and observation index which they are used areinconsistent in differnt countries. In our country, the infants BPT just starts at early exploration stage.From 2004 to 2005, in view of the infants not combinating, according to"Guidelines for methacholine and exercise challenge testing by the ATS Board", we established tradition tidal method BPT, which used the passive method that is the humidity breathing method to inhaled the stimulation medicine, and used it at clinic. It has great help to auxiliary diagnosis the asthma for infants. But in the application we discovered that this method's steps are tedious, for every person's inspection takes too long and the whole process needs about 90~120min. Along with the time extension and medicine stimulation, the waked rate increased and interrupted the BPT. So it can't meet the clinical needs. If we can improve the traditional BPT complex steps and decreased the examination time to obtains a standard method which has high sensitivity, specificity and safe to fit clinical application,it would provide an objective evidence for clinician to diagnosis asthma.Objective:To improve the preliminary establishment infants traditional tidal breathing method BPT, and establish a high efficiency infants BPT-- improved tidal breathing method BPT. Preliminary to appraisal its sensitivity, reliability and safety.Methods:To improve the 10 concentration gradient multiplicative Mch solution aerosol rebreathing method, of which dosage are 49ug/ml to 25mg/ml in the traditional tidal breathing method BPT,with simplifying it into 4 concentration gradient, the 0.5mg/ml, 2mg/ml, 8mg/ml and 16mg/ml, Mch solution aerosol rebreathing method. Also to omit inhalation physiological saline and select the before stimulation's lung function data as the foundation data directly.46chronic cough infants, 22 catabasis asthma infants and 10 control infants are carried on BPT and tested the lung function with lung function meter for infants—SensorMedics2600 made in Sendy Company in U.S.A to the 3 group infants. It is carried out traditional tidal breathing method BPT in the 20 chronic cough infants, 10 catabasis asthma infants and 10 control infants while for the 23 chronic cough infants, 12 catabasis asthma infants(used the) improved tidal breathing method BPT, respectively. And lungs symptom, SaO2, Rrs, %T-PF and %V-PF the five synthetic indexes are used as the positive judgment for improved tidal breathing method BPT, however, traditional tidal breathing method BPT used SaO2 as it's positive judgment.Results:1. In the two tidal breathing method BPT, the catabasis asthma group's BPT rate is completely positive, the chronic cough group positive rate of BPT is 60.0%, 69.57%, respectively, control group's BPT rate is completely negative. There is no significant difference at positive rate(P>0.05) and degree of airway hyperresponsiveness in the two groups which were carried out BPT by the two tidal breathing methods. There is no significant difference in lung function index before the provocation test (P>0.05)and only %V-PF had significant difference (p < 0. 01) in the chronic cough infants after the provocation test in which the decent rate is more obvious by using traditional tidal breathing method BPT.2. The whole BPT process would needs 4~13 times and spends 90~120 min for each infants in the traditional tidal breathing method BPT, while in the improved tidal breathing method BPT, it is only needs 3~6 times, spends 25~35min. There are 30% infants appears cough, 6.67% infants appears heart rate slow-down to 60 time/min in traditional tidal breathing method BPT, and 17.14% infants appears cough, none heart rate excessively slow in improved tidal breathing method BPT, respectively.Conclusion: 1. Compared with the traditional tidal breathing method BPT, there is no significant difference in the sensitivity, specificity on the reflection of the AHR by the improved tidal breathing method BPT. And also its untoward effects is few and security is high.2. Compared with traditional tidal breathing method BPT, the improved tidal breathing method BPT obviously rise the examination efficiency and reduce examination time. So it is more suitable for the sleeping condition infants to carry on BPT. PART 2 EXPLORATORY DEVELOPMENT THE IMPROVED TIDAL BREATHING METHOD BPT AT THE CHRONICITY COUGH DIAGNOSIS IN INFANTSObjective:To investigate the clinical application of improved tidal breathing method BPT, especially the sensitivity, reliability, safety and clinical usability to diagnosis the CVA.Methods:Selected 111 chronic cough infants, 63 catabasis asthma infants and 52 follow-up infants in that of two groups and tested the lung function with lung function meter for infants—SensorMedics2600 made in Sendy Company in U.S.A to each group infants. Carried out improved tidal breathing method BPT to all the infants, and lungs symptom, SaO2, Rrs, %T-PF and %V-PF the five synthetic indexes are used as the positive judgment.Results:1. The positive rate in 110 cases chronic cough infants is 75.45 % in the improved tidal breathing method BPT, while it is 95.24% in 63 cases catabasis asthma infants. There are significant differences at positive rate and the degree of airway hyperresponsiveness in the two groups(P<0.05). The 10 cases are all negative in control group. 2. All infants have not appeared the cyanosis, respiratory embarrassment and serious asthmatic attack, in the provocation test process. SaO2 is decreased, respiratory rate and heart rate are increased comparing with that of before the provocation , respectively. There is significant difference of them in the chronic cough group and catabasis asthma group(P<0.01), and no significant difference of them in control group(P>0.05). There are 34.55%, 46.03% appearing expiratory wheezing, and 20.00%, 23.81% appears cough, respectively, in the two groups, while there is none appearing expiratory wheezing and cough in control group.3. After the treatment, the 52 follow-up cases'BPT positive rate is 56.67% and 68.18% in the CVA group and the catabasis asthma group, respectively. And they have significant decreased comparing with the first examination's positive rates(P< 0.05). After the treatment, the two groups negative rate are 43.33%, 31.82%, respectively, and there is no significant difference of the which(P> 0.05). The AHR's degree are better, obviously, compared with the before treatment. The treatment effective power is 86.67%, 86.36%, respectively, and hasn't significant difference(P> 0.05).Conclusion:1. There is none seriously untoward effects appearing in using the five synthetic indexes which is lungs symptom, SaO2, Rrs, %T-PF and %V-PF to examine the AHR of infants as the positive judgment for BPT. It is more security and tolerance 2. It is a very important objective inspection for chronic cough's etiological diagnosis in paediatrics, which has extremely important help for chronic cough whether could diagnosed CVA, and also very important to the follow-up infants of CVA.