Objective To study the efficacy and safety of low-dose azithromycin with tiotropium bromide in the treatment of stable chronic obstructive pulmonary disease.Methods A hundred and ten patients were randomized into three groups:tiotropium bromide group (36 cases,group A),azithromycin with tiotropium bromide group(38 cases,group B)and control group(36 cases,group C).Patients in group A were given tiotropium bromide (18 μg,q,d )in addition to conventional treatment.The patients in group B were given lowdose azithromycin (250 mg,twice a week) in combined with tiotropium bromide.The patients in control group were given the conventional treatment only.The courses of treatment lasted for six months.Results Compared with the control group,the frequency of acute exacerbation in patients treated with azithromycin and tiotropium bromide was reduced remarkably ( 2.1 ± 0.6 and 4.9 ± 0.7,t =18.5061,P ＜ 0.05 ).The severity of clinic symptoms ( Cough 1.3 ± 0.5 vs.2.2 ± 0.6,P ＜ 0.05 ),expectoration ( 1.0 ± 0.2 vs.1.7 ± 0.3,P ＜ 0.05 ),anhelation ( 1.5 ± 0.8 vs.2.1 ± 0.6,t =3.6342,P ＜ 0.001 ) ],life quality ( 29 ± 8 vs.42 ± 11,P ＜ 0.05 ) and six-minutes walking distance( [ 370.00 ± 14.26 ] m vs.[ 290.00 ± 12.85 ] m,P ＜ 0.05 ) of the azithromycin with tiotropium bromide group were improved significantly when compared with control.Compared with the tiotropium bromide group,the frequency of acute exacerbation ( 2.1 ± 0.6 vs.3.2 ± 0.8,P ＜ 0.05 ),the severity of clinic symptoms (Cough 1.3 ±0.5 vs.1.8 ±0.4,P＜0.05),expectoration( 1.0 ±0.2 vs.1.3 ±0.3,P ＜0.05) and anhelation( 1.5 ±0.8 vs.1.9 ± 0.6,P ＜ 0.05 ) ],life quality ( 29 ± 8 vs.36 ± 10,P ＜ 0.05 ) and six-minutes walking distance ( [ 370.00 ± 14.26 ] m vs.[ 330.00 ± 13.76 ] m,P ＜ 0.05 ) were improved over those of tiotropium bromide group.Conclusion The long-term low-dose azithromycin in combinned with tiotropium bromide is good and safe in treating stable COPD.Therefore,it is worth of further clinical evaluation.

This paper summarized professor WANG Shouchuan's experience in differentiating and treating children epistaxis from the perspective of "four excess and three deficiency". It is believed that the pathogenesis of children epistaxis is concluded as "four excess and three deficiency"， of which the four excess syndromes are exuberant heat in the lung channel， intense stomach fire， heart fire hyperactivity， and liver fire flaming upward， while the three deficiency syndromes include qi， yin and yang deficiency. Seven methods for treating children epistaxis are summarized. For exuberant heat in the lung channel syndrome， it is recommended to clear lung and direct qi downward， using self-made Xiebai Zhiniu Decoction （泻白止衄汤）. For intense stomach fire syndrome， the method of clearing stomach and draining fire can be used with self-made Qingwei Zhiniu Decoction （清胃止衄汤）. In terms of heart fire hyperactivity syndrome， it is better to clear heart and drain fire， using self-made Daochi Zhiniu Decoction （导赤止衄汤）. For liver fire flaming upward syndrome， it is advised to clear liver and drain fire， using self-made Yimu Zhiniu Decoction （抑木止衄汤）. In terms of qi deficiency syndrome， the method of fortifying spleen and boosting qi and containing blood should be used with self-made Futu Zhiniu Decoction （扶土止衄汤）. If there is yin deficiency syndrome， it is advised to supplement kidney， enrich yin and clear heat， using self-made Zishui Zhiniu Decoction （滋水止衄汤）. If there is yang deficiency syndrome， the method of boosting qi， warming yang and nourishing blood can be used， using self-made Wenpi Zhiniu Decoction （温脾止衄汤）.