A Clinical Research On Treatment Of Asthma By Applying Combination Of Aerosol Inhalation

Background Bronchial asthma is one kind of common disease in the respiratory system. There are about three hundred millions asthma patients in the world . The average incidence of the asthma is about 1%-18% and it has a tendency to be higher and higher yearly. This increase tendency of the incidence take a great burden to the economics of the country ,even the world's. In the present , the bronchial asthma is thought to be one kind of illness that is a chronic inflammatory disease caused by many cells and cellular component ,such as eosinophile granulocyte (EOS), T lymphocyte,Mast cells,neutrophile granulocyte,airway cellula epithelialis.The chronic inflammatory can cause the increase of the hyper–responsive in the airway and valuable flow limitation. This disease has many symptoms such as wheeze, shortness of breath, chest distress and cough.It is paroxysmal and more often at midnight and early morning . most patients can relieve by themselves or through the promptly treatment. Repeated outbreak of the asthma and the interaction of the cells and cellular factors can induce the thickening of airway , in the end the airway remodeling . Then the reversible flow limitation turn to the inreversible airflow obstruction. WHO has take the asthma as a life long treatment disease. The key of the treatment is the relieve and control the outbreak of the asthma .In the present , the major method to treat asthma advocated in the world is the combination inhalation of aerosolβ2 agonists (β2AG) and Glucocorticoid.β2AG has the character of high selectivity so that it can avoid the side effect of the systemic medicine and it can also avoid the heart throb and the arrhythmia induced by the non-selective excitation of the beta1 receptor ofβ2AG in the heart . 10% -20% of the drug can reach into the low respiratory airway and excite theβ2Adrenergic receptor(β2AR ) ,then it can diastole the bronchial smooth muscle and relive the symptoms of bronchial spasm.The drug can suppress the hyperplasia of the smooth muscle cells and the secretion of the inflammatory mediator,improve the function of the mucous and flagella, protect the mucosa of airway,reduce the permeability of vessels, regulate the activity of eosinophile granulocyte (EOS), T lymphocyte, Mast cells,neutrophile granulocyte,airway cellula epithelialis to anti-inflammatory in the end . Even though theβ2AG has many advantages , it can not avoid the subsencitization by long time use and this can cause the diastole effect weaken and the shorten of the drug duration. What's more, the use of theβ2AG in the long term can also increase the mortality ,so it is rational to combination inhalation theβ2AG and ICS . this method is widely accepted as first-line agents to treat asthma because of its prompt act on the target organ , rapid relief the systemic symptoms ,low blood concentration and the few side effect. The combination inhalation of theβ2AG and ICS has obvious synergy:β2AG can increase the combine of GR and GCS , reinforce the anti-inflammatory function of GCS and the diastole function of theβ2AG can gain more time for the GCS work. ICS can increase the transcript of theβ2AR in the membrane of the lung tissue cells and synthesis of the receptor protein in the airway mucosa and it can also reverse the desentization and the drug resistance by the long term use ofβ2AG. Combination inhalation of GR and ICS has been widely accepted for its correction the immune inbalance,airway hypersensitivity and improvement the lung function and be favored by people ,especially the clinical medical workers.Subjection: To investigate the effect of terbutaline combination inhalation of budesonide by the acute attack asthma patients on theβ2AR, T lymphocyte subgroup , eosinophile granulocyte (EOS), and lung function and further bring forth the new method in treat the bronchial asthma.Method : Choose 56 patients of moderate and severe acute attack asthma , distribute them into two group: the control group ,28 patients and the treatment group,28 patients. Treat the patients in the control group through the common method such as doxofylline ,glucocoticoid etal; and the treatment group gets an additional treatment by applying combination inhalation: 0.9% NaCl 3ml + budesonide 2mg and 0.9% NaCl 3ml + terbutaline 0.25g, two times a day ; measure the theβ2AR, T lymphocyte subgroup , EOS, and lung function pro– and post- treatment. and then compare the every index to determine whether the improvement has the statistic significance.Result: 1.The level ofβ2AR of the peripheral blood in the bronchial asthma patient in acute attack is lower than that of healthy people(P<0.05). The level of theβ2AR after treatment has no significant difference between the control group and the treatment group(P>0.05) . and the level ofβ2AR between pro and post treatment in the treatment group has no obvious decrease (P>0.05). 2.In the correction the inbalance of T lymphocyte subgroup , compare with the control group , the asthmatic patients in the treatment group are more obvious(P<0.05).3. The EOS level of the bronchial asthmatic patients in acute attack period increase obviously, and the level of the both groups decreases greatly after the treatment (P<0.05).However, the level is higher than the that of the healthy group patiernts.4. The asthmatic patients in acute attack period are obstructive ventilation , FEV1/FVC% and PEF decrease. After the treatment ,both of the index increase obviously (P<0.05). and the increase is more obvious in the treatment group than that in the control group(P<0.05).Conclusion: 1. Theβ2AG level in the bronchial asthmatic patients is lower than that in the healthy people. After the combination inhalation of the budesonide and terbutaline, the level has no obvious decrease. GCS has effect on the beta2 adrenergic receptor desensitization caused byβ2AG. 2. Bronchial asthma is a immune related disease. In the asthmatic patients, the level of the T lymphocyte subgroup is changed. The function of CD4+T cells improved , the level of CD4+T/CD8+T inbalanced. Combination inhalation can correct the inbalance of the lymphocyte subgroup. 3. EOS is the major effect cells in chronic airway inflammatory of asthma. When the patient is onset , the peripheral blood EOS in the smooth muscle is increased obviously and decreased with the relief of the symptoms, but higher than that of the healthy people. This suggest that EOS has an important role in the mechanism of the asthma. 4. The combination inhalation can improve the ventilation function of the bronchial asthma patient in acute attack period. 5. The combination inhalation has synergy function and it can treat the acute attack in every stage , and it has obvious effect on the relief and control the acute attack in the treatment. so it should be commended widely.