Although refractory asthma is likely 5%～10% of total asthma,it accounts for a substantial proportion of the health costs.This paper will serve as an aid to defining,understanding,identifying causative factors and managing these refractory patients.

Objective To investigate the correlation between occurrence time and condition severity in patients of bronchial asthma complicated with allergic rhinitis. Methods The 583 outpatients with asthma in an asthma clinic during 1996-2002 were divided into simple asthma group (Group Ⅰ with 292 cases) and asthma complicated with allergic rhinitis group (Group Ⅱ with 291 cases), and their data were compared and statistically analyzed. Results The proportion of those complicated with other diseases, e.g. , nasal polyp, sinusitis, atopic dermatitis, and with a history of allergy, e.g. , food allergy, drug allergy and positive skin allergic test, was significantly higher in the Group Ⅱ than that in the Group Ⅰ ( P

0. 05) , mid-upper arm circumference and serum prealbumin (PA) were clearly improved (P

0.05).(4)The para-operation pulmonary function indexes(VC,VC%,FEV1)of the patients who had the variation of ECG were significantly lower than those of no-complication patients.(P

Objective To investigate the clinical and laborat ory characteristics of SARS patients complicated with underlying diseases.Methods 1 291 patients clinically diagnosed as SARS defined by Chinese Ministry of Health reported in Beijing area were analyzed retrospect ively in our study.Results In 1 291 cases,there were 27.5% patients with unde rlying diseases,in which,65.6% cases were 40 years or older.There were 72.5% p atients without underlying diseases,in which,74.6% cases were 40 years or young er.Hypertension,diabetes mellitus and coronary heart disease were the most commo n underlying diseases of SARS.Clinical symptoms and signs of SARS in underlying diseases group were more than that in without underlying diseases group (P

Objective To evaluate the impact of the asthma education and management model developed by Peking University People's Hospital on the level of asthma control. Methods Trained respiratory physicians from 6 large teaching hospitals in the urban districts of Beijing conducted a successive questionnaire survey in the form of face-to-face interviews with adult asthma patients attending their respective clinics. The results were used to compare the levels of asthma control between patients who were administered "three-in-one" asthma education and management (education group) and those who were not(control group). Results Among the 100 patients in the education group, 85% showed asthma control test(ACT) values ≥20 points. This was significantly higher than that in the 427 control group patients (37%,χ2 =74.345 ,P <0.01 ). During the past 1 year, the rate of hospitalization due to exacerbation of asthma,number of emergency treatments, and missed working days were significantly lower in the education group than in the control group ( 4%, 18%, 20% vs 23%, 32%, 55%, respectively; χ2 = 19.431,7.515 and 17.853 respectively; and P < 0.01 for all). Conclusion The " three-in-one" asthma education and management model can significantly improve asthma control.

Objective To investigate the clinical manifestation and outcome of severe acute respiratory syndrome (SARS).Methods The clinical data of 233 patients with SARS admitted to China-Japan Friendship Hospital from April 2003 to June 2003 were analyzed,including clinical manifestations,laboratory findings,chest radiograph,outcome and mortality of SARS.Results There were 115 male and 118 female patients in this cohort,aged 13-86 (mean 42 8?18 5yr);43 3%of the patients had one or two kinds of underlying diseases;73 0% of the patients had a history of SARS close contact. Incubation period was 1-21 days (mean 4 9?4 1d).The initial symptoms were fever in 86 3% of the patients.The respiratory symptoms were found after the onset of 1-2 weeks.The laboratory abnormalities were decreased in WBC (56 7%) and lymphocytes (78 5%).Corticosteriod was used in 69 5% of the patients.There were 10 deaths (4 3%).The elder age,underlying diseases,continued high fever, thrombocytopenia,leucocytosis and bilateral lung involvement were the risk factors.Conclusion SARS is a new and strongly contagious disease,which mainly affects youth and people in their prime life.It has its own characteristic clinical manifestations.There is high mortality in severe cases.The prognosis is poor in patients complicated with diabetes,leucocytosis,lymphocytopenia,thrombocytopenia and elevated serum LDH and CPK.

n clinic.

Objective To learn the degree of the asthmatic patients'understanding of the disease, and to provide references for formulating the plan of the asthma patient's education and management infuture.Methods One hundred and one outpatients were surveyed by questionnaire face to face.Results Among 101 patients,the percentages of mild intermittent,mild persistent,moderate persistent and severepersistent asthma assessed by current symptom were 23%,29%,30%,18%.Among these patients thosewho understanding the inflammatory nature of asthma account occupied 70.3%,those who realizing the importance of inhaled corticosteroids(ICS)and taking ICS as the first-line medicine for asthma occupied67.3%,those who knowing the indication about rational use of short-acting beta-2-agonists(SABA)occupied 88.1%,those who realizing the goal of asthmatic therapy occupied 71.3%.All these results were significantly better than both the reporter in the asthma insights and reality in Asia-Pacific and the realizing degree to asthma of the respiratory professionals in Beijing's urban district hospitals in 1997.Conclusion After long term systematic education and management,asthmatic patient's understanding of the disease has been improved greatly.

Objective To investigate the clinical effects differences of three-port and single-port invasively combination laparoscopic cholecystectomy and appendectomy in the treatment of acute appendicitis complicated with gallbladder stone. Methods 110 patients with acute appendicitis complicated with gallbladder stones from August 2012 to August 2015 were randomly divided into control group (55 patients) with three-port laparoscopic operation and observation group (55 patients) with single-port laparoscopic operation;and the clinical indexes for operation related, operation overall satisfaction score of Brown, the VAS score of depression and anxiety before and after operation and postoperative complications of both groups were compared. Results The incision length of observation group was significantly shorter than control group (P< 0.05). The operative time of observation group was significantly longer than control group (P < 0.05). The operation overall satisfaction of Brown of observation group was significantly higher than control group (P < 0.05). The VAS score of depression and anxiety after operation of observation group was significantly better than control group and before operation (P<0.05). There was no signiifcant difference in the incidence of postoperative complications between 2 groups (P < 0.05). Conclusion Compared with three-port laparoscopic operation, single-port invasively combination laparoscopic cholecystectomy and appendectomy in the treatment of acute appendicitis complicated with gallbladder stone can efifciently decrease the incision length, improve the aesthetic degree and postoperative negative emotions and not lead to increased risk of postoperative complications.