A previous questionnaire interview had revealed that betelnut chewing may aggravate asthma in 61% of asthma patients attending an outpatient clinic at Port Moresby General Hospital; the rest said it had no effect. The aim of the present study was to verify patients' subjective feelings through objective measurements. 7 asthma patients (Group C) who said betelnut aggravated their asthma, 8 asthma patients (Group B) who denied any effect and 8 nonasthmatic, healthy subjects (Group A) were given betelnut with accompanying ingredients and asked to chew as they would usually chew it. Their spirometric forced expiratory volume in the first second (FEV1) readings, heart rate and blood pressure were monitored before and after this challenge. Group A nonasthmatic subjects experienced only minor rises and falls in their FEV1 in response to betelnut chewing. 3 patients in Group B experienced overall rises (mean maximal % rise 25 +/- 19) while 5 patients had overall falls (mean maximal % fall 11 +/- 6). In Group C 1 patient had an overall rise in her FEV1 (maximal rise 10%) while 6 patients had falls (mean maximal % fall 22 +/- 7). In all groups the heart rate increased in response to betelnut. Betelnut chewing caused bronchoconstriction as demonstrated by decreases in FEV1 in a majority of the asthmatic patients studied; hence betelnut may act as a trigger factor for their asthma. In a few others increases in FEV1 were noted, while the rest experienced only minor changes.
Adult ; aged ; Areca - physiology ; Asthma - physiopathology ; Case-Control Studies ; Forced Expiratory Volume - drug effects

OBJECTIVETo evaluate the efficacy and safety of loratadine, a new generation of antihistaminics, in the treatment of childhood asthma.

METHODSThe papers related to loratadine treatment for childhood asthma were searched in the database of PubMed, MEDLINE, EMBASE, Cochrance, CNKI and CBMdisc (January 1990 to December 2010) electronically and manually. According to the Cochrane reviewer's handbook, the quality of the enrolled papers was assessed and a systematic review was performed.

RESULTSA total of 179 papers were obtained. Eleven randomized controlled trials met the criteria and were included in this study. The 11 trials included 317 children with asthma: 159 cases in the loratadine treatment group and 158 cases in the control group. All included studies belonged to the B class according to the quality evaluation criteria. Meta analysis showed that the clinical symptoms were improved more, the forced expiratory volume in 1 second (FEV1) 4 and 8 weeks posttreatment and the peak expiratory flow rate (PEFR) 8 weeks posttreatment were higher in the loratadine treatment group than in the control group. The treatment-related adverse effects, fatigue, tachycardia and palpitation, occurred less in the loratadine treatment group compared with the control group.

CONCLUSIONSLoratadine is safe and effective for the treatment of childhood asthma.

Anti-Allergic Agents ; therapeutic use ; Asthma ; drug therapy ; physiopathology ; Forced Expiratory Volume ; Humans ; Loratadine ; adverse effects ; therapeutic use ; Peak Expiratory Flow Rate

OBJECTIVETo investigate the effect of long-term exposure to toluene diisocyanate (TDI) on the lung function of TDI-exposed workers.

METHODSA factory was selected for this occupational epidemiological investigation. The workers who were exposed to TDI and had complete physical examination records in recent 3 years were the exposed group (n = 45), while the company's administrative staff, logistics staff, and other non-TDI-exposed workers who had complete physical examination records in recent 3 years were the control group (n = 47). The two groups were compared in terms of lung function indices.

RESULTSCompared with the control group, the 2009 exposure group had significantly lower forced expiratory volume in one second (FEV1.0), FEV1.0/forced vital capacity (FVC), and maximal expiratory flow at 25% of FVC (MEF25) (P < 0.05), the 2010 exposure group had significantly lower FEV1.0, FEV1.0/FVC,maximum voluntary ventilation (MVV), and maximal expiratory flow at 50% of FVC (MEF50) (P < 0.05), and the 2011 exposure group had significantly lower FEV1.0, FEV1.0/FVC, peak expiratory flow (PEF), MEF25, and MEF50 (P < 0.05).

CONCLUSIONLong-term exposure to TDI can lead to certain impairment of lung function in workers, which may be reflected by decreased lung function indices such as vital capacity, FVC, FEV1.0, FEV1.0/FVC, PEF, and MVV.

Case-Control Studies ; Forced Expiratory Volume ; Humans ; Lung ; drug effects ; physiopathology ; Male ; Occupational Exposure ; Toluene 2,4-Diisocyanate ; adverse effects ; Vital Capacity ; drug effects

OBJECTIVETo verify the clinical efficacy of Xiaochuangao acupoint paste (XAP) in treating asthma in children.

METHODNinety children patients with asthma were randomly assigned to three groups with 30 patients each, being treated with XAP, hormone and XAP combined with hormone, respectively. The changes of the lung function and the recurrence times during one-year follow-up were observed.

RESULTGroup II (Hormone group) saw higher total effective rate (69.2%) than Group I (XAP group) (63.3%) , but with no statistic difference between these two groups. Group llI (XAP and Hormone) saw the highest total effective rate (93.1%), with significant statistic difference from the other two groups (P < 0.05). All three groups saw the significant increase of the levels of FEV1, FEV11/FVC and PEF after the treatments (P < 0.05), while no statistical difference of FEV1, FEV1/FVC, PEF were observed in the three groups before the treatments. After the treatments, statistic differences of FEV1, FEV1/FVC, PEF between Group Ill and Group II were observed (P < 0.05).

CONCLUSIONXAP played a role in preventing the recurrence of asthma in children. Combined with hormone, XAP showed better effects.

Acupuncture Points ; Asthma ; drug therapy ; physiopathology ; prevention & control ; Child ; Child, Preschool ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Forced Expiratory Volume ; drug effects ; Humans ; Male ; Seasons ; Secondary Prevention

Adolescent ; Adrenergic beta-Agonists ; therapeutic use ; Albuterol ; analogs & derivatives ; therapeutic use ; Asthma ; drug therapy ; physiopathology ; Child ; Child, Preschool ; Female ; Forced Expiratory Volume ; drug effects ; Humans ; Male ; Salmeterol Xinafoate

PURPOSE: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease (COPD) uses the post-bronchodilator spirometry for diagnosis and severity staging. We evaluated differences in the severity classification of COPD, based on pre- and post-bronchodilator spirometry. MATERIALS AND METHODS: From 2000 to 2004, 207 COPD patients who underwent spirometry before and after inhalation of 400 microg of fenoterol were analyzed. A responder to the bronchodilator test (BDT) was defined by the American Thoracic Society (ATS) as an increase in forced expiratory volume in one second (FEV1) or forced vital capacity > or = 12% and > or = 200 mL, and by the European Respiratory Society (ERS) as an increase in FEV1 > or = 10% of the predicted value. COPD severity was classified according to the 2008 GOLD guidelines. RESULTS: For the entire study population, the FEV1 increased by 11.8 +/- 12.5% of baseline after BDT and 41.1% and 27.1% of subjects were classified as responders using the ATS and ERS criteria, respectively. Based on pre-BDT spirometry, 55, 85, 58, and 9 patients were classified as Stage I-IV COPD, respectively. Sixty-seven (32.4%) patients changed severity staging after BDT, including 20.0%, 28.2%, 44.8%, and 66.7% of pre-BDT patients Stages I through IV, respectively. More ATS or ERS BDT-responders had a change in severity staging than non-responders (52.9% vs. 18.9% and 62.5% vs. 21.2%, both p < 0.001). CONCLUSION: Our data suggest that the severity staging of COPD using pre-BDT spirometry might lead to significant differences as compared to staging, based on post-BDT spirometry, as recommended by the current GOLD guidelines.
Bronchodilator Agents/*diagnostic use ; Fenoterol/diagnostic use ; Forced Expiratory Volume/drug effects ; Humans ; Practice Guidelines as Topic ; Prognosis ; Pulmonary Disease, Chronic Obstructive/*diagnosis ; Spirometry/methods

OBJECTIVETo observe changes in the lung function of asthmatic children with different symptoms during treatment, and to investigate the clinical significance of bronchial reversibility test in the treatment of asthma in children.

METHODSA total of 417 asthmatic children were treated by salmeterol/fluticasone inhalation for more than 3 months. These patients were divided into asymptomatic, single cough, paroxysmal cough and wheeze (cough+wheeze or wheeze alone) groups based on the symptoms when they revisited the clinic. Thirty-four healthy children were used as a control group. All children underwent bronchial reversibility test using nebulized salbutamol. Lung function testing was performed before and after the test.

RESULTSAfter nebulization of salbutamol, each asthma group showed significantly decreased rate of abnormal lung function and significantly increased forced expiratory volume in one second percent (FEV1%) predicted (P<0.05). Before salbutamol nebulization, the single cough, paroxysmal cough and wheeze groups had significantly higher rates of abnormal lung function and significantly lower FEV1% predicted than the control group (P<0.05). There were significant differences in the rate of abnormal lung function and FEV1% predicted among the asthma groups (P<0.05). After salbutamol nebulization, the paroxysmal cough and wheeze groups had significantly higher rates of abnormal lung function than the control group (P<0.05), but there were no significant differences between other asthma and control groups; the wheeze group had significantly lower FEV1% predicted than the control group, but no significant differences were found between other asthma and the control groups. The positive rate of bronchial reversibility test in each asthma group was significantly higher than in the control group (P<0.05). There were significant differences in the positive rate of the test between the asthma groups except between the asymptomatic and single cough groups (P<0.05).

CONCLUSIONSAsthmatic children with different symptoms demonstrate different lung functions during treatment. Bronchial reversibility test combined with lung function test is useful in assessing asthma control and guiding treatment.

Administration, Inhalation ; Adolescent ; Albuterol ; administration & dosage ; adverse effects ; analogs & derivatives ; Androstadienes ; administration & dosage ; adverse effects ; Asthma ; drug therapy ; physiopathology ; Bronchi ; physiopathology ; Child ; Drug Combinations ; Female ; Fluticasone-Salmeterol Drug Combination ; Forced Expiratory Volume ; Humans ; Lung ; physiopathology ; Male

BACKGROUNDMany studies have shown the superior efficacy of budesonide (BUD)/formoterol (FORM) maintenance and reliever therapy, but still lack evidence of its efficacy in Chinese asthma patients in a relative large patient-group. We finished this research to compare BUD/FORM maintenance and reliever therapy and high-dose salmeterol (SALM)/fluticasone (FP) maintenance plus an as-needed short-acting β(2)-agonist in Chinese patients with persistent uncontrolled asthma. This was a post hoc analysis based on a 6-month, multicenter, randomized, double-blind study (NCT00242775).

METHODSA total of 222 eligible asthma patients from nine centers in China were randomized to either BUD/FORM+as-needed BUD/FORM (160/4.5 µg/inhalation) (640/18 µg/d; n = 111), or SALM/FP+as-needed terbutaline (0.4 mg/inhalation) (100/1000 µg/d; n = 111). The primary endpoint was time to first severe exacerbation while secondary endpoints included various measures of pulmonary function, symptom control and quality-of-life.

RESULTSTime to first severe exacerbation over six months was lower with the BUD/FORM than with the SALM/FP treatment (risk ratio = 0.52, 95%CI 0.22 - 1.22), but the difference did not achieve statistical significance (P = 0.13). The cumulative number of severe exacerbations in the BUD/FORM group was lower than in the SALM/FP group (7.2% vs. 13.5%; risk ratio = 0.45, P = 0.028). BUD/FORM produced significantly better improvements in reliever use, cumulative mild exacerbations, symptom-free days (%), and morning/evening peak expiratory flow (PEF) than SALM/FP (P < 0.05 in all cases). The two groups achieved similar improvements in their time to first mild exacerbation, forced expiratory volume in one second (FEV(1)), asthma control questionnaire and asthma symptom scores, and percentage of nights with awakening(s). Both treatments were well tolerated.

CONCLUSIONSIn Chinese patients with persistent asthma, BUD/FORM decreased severe and mild exacerbations, decreased reliever use, increased symptom-free days, and improved morning/evening PEF compared with SALM/FP. There were no significant differences in time to first severe exacerbation or other assessments regarding daily asthma control between BUD/FORM and SALM/FP. BUD/FORM was more effective in this Chinese sub-group than in the total cohort involved in the original study.

Adolescent ; Adult ; Aged ; Asthma ; complications ; drug therapy ; physiopathology ; Budesonide ; administration & dosage ; adverse effects ; Double-Blind Method ; Ethanolamines ; administration & dosage ; adverse effects ; Female ; Forced Expiratory Volume ; Formoterol Fumarate ; Humans ; Male ; Middle Aged

PURPOSE: Low-dose theophylline has anti-inflammatory effects. The aim of this study was to evaluate the effects of adding theophylline compared with increasing the dose of inhaled corticosteroid (ICS) on symptomatic asthma. MATERIALS AND METHODS: The associated literature was acquired through deliberate searching and selected based on the established inclusion criteria for publications. The extracted data were further analyzed by a meta-analysis RESULTS: Four randomized, controlled, parallel studies were selected. Addition of theophylline produced a greater increase of forced expiratory volume in one second as %predicted (FEV1pred) by 2.49% [95% confidence interval (CI) 1.99-3.00; z = 9.70; p < 0.001], compared with increasing the dose of ICS. There was no difference between the two treatments in terms of peak expiratory flow (PEF). CONCLUSION: Addition of theophylline to ICS has similar therapeutic effects on improving lung function as increasing the dose of ICS in the treatment of symptomatic asthma.
Adrenal Cortex Hormones/administration & dosage/*therapeutic use ; Anti-Asthmatic Agents/administration & dosage/*therapeutic use ; Asthma/*drug therapy ; Forced Expiratory Volume/drug effects ; Humans ; Randomized Controlled Trials as Topic ; Theophylline/*therapeutic use ; Treatment Outcome

Smoking is associated with poor symptom control and impaired therapeutic responses in asthma. A total of 843 patients with asthma were recruited. The patients received treatment for 1 yr according to the severity of their asthma. We compared the forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 to forced vital capaity (FVC), atopy, total IgE, emphysema on high-resolution computed tomography (HRCT), the number of near-fatal asthma attacks, and physiological fixed airway obstruction between the smoking and nonsmoking groups. The study population consisted of 159 (18.8%) current smokers, 157 (18.7%) ex-smokers, and 525 (62.5%) nonsmokers. Although the prevalence of atopy was not different between the smoking and nonsmoking groups, the total IgE was higher among the smokers than the nonsmokers. Compared with the nonsmoking group, the smokers had a lower FEV1 % predicted and forced expiratory flow between 25 and 75% of FVC. A greater prevalence of emphysema and a significantly higher number of asthmatic patients with fixed airway obstruction were detected in the smoking versus nonsmoking group. The 37.5% of asthmatic patients who were former or current smokers showed decreased pulmonary function and increased IgE, emphysema on HRCT, and fixed airway obstruction, indicating that smoking can modulate the clinical and therapeutic responses in asthma.
Airway Obstruction/etiology ; Asthma/complications/*diagnosis/*drug therapy ; Female ; Forced Expiratory Volume/physiology ; Humans ; Immunoglobulin E/analysis ; Male ; Middle Aged ; Pulmonary Emphysema/etiology/radiography ; Respiratory Function Tests ; Respiratory Insufficiency/etiology ; Smoking/*adverse effects ; Tomography, X-Ray Computed