摘要
目的临床医师每天面对的支气管哮喘（简称哮喘）患者复杂多样，如何针对每例患者的具体情况，选择合适的药物种类和剂量，实现哮喘控制目标，是需要解决的问题。方法对2008年5月至2009年3月北京协和医院呼吸科门诊控制不好的32例哮喘患者在治疗的同时进行2周动态肺量和症状监测，对其中4例进行病例分析和文献复习。结果例1患者中年女性，咳嗽喘息10余天，夜间症状明显。2周动态肺量监测同时妥洛特罗贴剂2mg／晚。监测初期第1秒用力呼气容积和最大呼气峰流速明显晨降，随治疗进展第1秒用力呼气容积恢复正常，最大呼气峰流速晨降消失。2周后患者开始了联合吸人肾上腺糖皮质激素和长效β2受体激动剂的治疗。例2老年女性，哮喘10多年，未正规治疗。开始联合吸入肾上腺糖皮质激素和长效β2受体激动剂治疗时，短期加用妥洛特罗贴剂，2周后肺功能基本恢复正常，未出现心血管系统不良反应。例3咳嗽变异性哮喘，吸人肾上腺糖皮质激素气雾剂后咳嗽加重，改妥洛特罗贴剂和复方甲氧那明全身用药，咳嗽很快缓解。2周后开始吸人肾上腺糖皮质激素干粉剂。3个月随访，症状控制。例4长期没有控制好的哮喘，需要寻找合适的治疗方案，联合吸入肾上腺糖皮质激素和长效β2受体激动剂治疗同时短期妥洛特罗贴剂，动态监测2周达到哮喘控制。结论针对患者具体情况制定个体化的诊疗方案有助于提高哮喘的控制水平。
Objective Tailoring bronchial asthma（asthma）treatment based on individual patient condition is an important issue in translation of guideline recommendations into real-world asthma control. Methods Thirty-two patients with poorly controlled asthma at pulmonary clinic of Peking Union Medical College Hospital from May 2008 to March 2009 were assessed and monitored for 2 weeks. Four cases were reported. Results Case one of a professional mid-age woman presented with cough and wheezing at night for 10 days. Daily, three times recording of spirometry demonstrated recurrent morning and（or） night falls in forced expiratory volume in 1 s（FEV1 ）and peak expiratory flow（PEF）,which improved significantly with tulobuterol patch 2 mg once-daily. Diagnosis was confirmed and combination of inhaled corticosteroid （ICS）and long-acting [β2-agonist（LABA）initiated. Case two of an elder woman presented with a recent exacerbation of 10-year poorly controlled asthma. ICS/LABA plus short-term use of tulobuterol patch relieved symptoms and achieved nearly normal lung function in two weeks without obvious cardiovascular side effect. Case three of a young man with cough variant asthma worsened with ICS,which was replaced by tulobuterol patch and oral methoxyphenamine with significant improvement. ICS turbuhaler was initiated a few weeks later and the patient appeared well at 3-month follow-up. Case four of long-term uncontrolled asthma needed an appropriate therapy. Two weeks of assessment and monitoring revealed good responsiveness to ICS/LABA and short-term use of tulobuterol patch. Long-term ICS/LABA was recommended. Conclusions Tailoring asthma treatment based on individual patient condition enhances asthma control.
出处
《国际呼吸杂志》
2010年第3期144-147,共4页
International Journal of Respiration
