| Objective:To investigate the effects of nebulized inhaled budesonide suspension and intra venous infusion of methylprednisolone on clinical symptoms and airway inflammatio n in patients with moderate to severe bronchial asthma during acute attack.Date and Methods:Clinical data: The subjects were 76 patients with acute exacerbation of moderat e to severe asthma diagnosed in the respiratory department of the First Hospital of Shanxi Medical University from January 1,2017 to May 31,2017.There were 25 males and 51 females,aged 16-85 years,with an average age of(47.72±18.60)yea rs.All patients were in accordance with the diagnostic criteria for moderate-to-sever e asthma developed by the Asthma Group of the Chinese Medical Association Resp iratory Diseases Society.Treatment methods: All patients were divided into two groups according to ran domization: 36 in the observation group and 40 in the control group.There was no significant difference in the general data of gender,age and condition between the patients(P>0.05),which was comparable.All patients with acute exacerbation of a sthma were given basic treatment: all patients had a short-acting bronchodilator: sal butamol aerosol,according to the severity of the disease,each time using 2-4 spray to relieve symptoms;if necessary,oxygen therapy.In addition,both groups of pati ents were given nebulized inhalation of terbutaline sulfate atomized solution,2.5 mg/ time,2 times / d.36 patients in the observation group were given nebulized inhalation of budesonide suspension,2 mg/time,2 times/d;40 patients in the control g roup were given intravenous infusion of methylprednisolone,40 mg/time,once/ d.T he treatment and observation time was 7 days.The clinical symptom scores of all patients before and after treatment were recorded.The score table refers to the Ast hma Control Test(ACT).All patients underwent lung function tests before treatmen t and 7 days after treatment,including forced expiratory volume in 1 second(FEV1),forced expiratory volume in 1 second(FEV1%pred),Peak expiratory flow(PEF),expiratory peak flow rate as a percentage of predicted value(PEF%pred)and othe r indicators.During the 7-day treatment period,qualified sputum samples were colle cted once a day and the percentage of sputum Eosinophils(Eos%)was counted.Al l patients were equipped with a peak flow meter.After training,the patient complet ed the PEF measurement and calculated the daily PEF variability and PEF mean va riability.Results:1.ACT score change: The average ACT score of the observation group before treatment was 12.98±4.14,20.75±2.92 after treatment,and the difference of ACT s cores before and after treatment was statistically significant(P<0.05).The average ACT score of the control group before treatment was 13.31±4.25,20.67±3.18 after treatment,and the difference of ACT scores before and after treatment was statistic ally significant(P<0.05).The ACT scores of the two groups were compared after 7days of treatment,and the difference was not statistically significant(P>0.05).2.Changes in lung function: The changes in lung function before and after tr eatment were compared in the observation group: FEV1%pred was 46.97±6.52% bef ore treatment,73.89±6.16% after treatment;pre-treatment PEF%pred was 69.14±4.40%,and after treatment was 84.76±5.10%,the difference of lung function before an d after treatment was statistically significant(P <0.05);The changes in lung functio n before and after treatment were compared in the control group: FEV1%pred was48.23±7.22% before treatment and 74.41±5.96% after treatment.The pre-treatment PEF%pred was 68.28±4.77%,and the treatment was 85.31±8.70%.The difference of lung function before and after treatment was statistically significant(P <0.05).Ther e was no significant difference in lung function between the two groups after 7 da ys of treatment(P>0.05).3.Comparison of the use of salbutamol aerosols: In the control group,the dai ly dose of salbutamol aerosol was 4.52+1.11 times in the observation group and 2.07+0.89 times in the observation group.The difference between the two groups wa s statistically significant(P<0.05).4.Changes in Eosinophil counts: 48 h after treatment compared with before tre atment: Eos% count(16.58±3.75%)in sputum after treatment for 48 h in observation group decreased by 75.33% compared with before treatment(67.20±7.21%),the dif ference was statistically significant(P<0.05);Eos% count(54.79±6.90)in the sputu m of the control group decreased by 17.98% compared with the pre-treatment(66.80±6.77)after 48 hours of treatment,and the difference was not statistically significa nt(P>0.05).After treatment for 96 hours and before treatment: Eos%(14.06±2.63)in the sputum after treatment for 96 h in the observation group decreased by 79.08% compared with before treatment(67.20±7.21),the difference was statistically sig nificant(P<0.05).Eos%(16.63±3.04%)in the sputum after treatment for 96 h in the control group decreased by 66.55% compared with that before treatment(66.80±6.77%),the difference was statistically significant(P<0.05).5.PEF daytime variability comparison: the average PEF daytime variability of the observation group(40.93±3.87%)and the control group(45.73±3.69%)were co mpared between the two groups.The difference between the two groups was statisti cally significant.P < 0.05).6.The relationship between Eos% and PEF daytime variability: There was a p ositive correlation between Eos% and PEF daytime variability in the two groups.T he observation group(r=0.581,P<0.05)and the control group(r=0.350,P < 0.05).Conclusion:Inhalation of glucocorticoids compared with intravenous infusions allows patient s with acute asthma attacks to control airway inflammation earlier,compared with i ntravenous drugs,and reduces systemic hormonal load.In clinical work,patients wi th acute exacerbation of moderate-to-severe asthma can first choose a medium-high dose inhalation mode of inhalation instead of the usual intravenous infusion method.From the point of view of the symptoms of asthma exacerbation,adequate inhalati on of glucocorticoids and intravenous hormones can improve symptoms,but atomiza tion therapy is effective,safe,and the systemic hormone load is reduced,which is a new treatment for acute asthma attacks.The development provides experimental b asis.In addition,this study found that Eos% in sputum was positively correlated wi th PEF daytime variability,suggesting that aerosolized glucocorticoids can effectivel y control symptoms by inhibiting local infiltration of Eos,thereby reducing the risk of acute attacks.Because the sample size of this study is relatively small,the abo ve conclusions need further research and verification. |
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