[ Abs tratc ] The revision in 2016 asthma management and prevention guideline includes both the diagnosis of asthma and the control-based asthma management .It points out that asthma is a heterogeneous disease , and the diagnosis of asthma should be based on the characteristic pattern of symptoms and evidence of variable airflow limitation, emphasizing the diagnosis of atypical asthma .Besides, the epidemiology of asthma, assessment of asthma , management severe asthma , special type of asthma and asthma in special populations have been added in this version .The revised guideline provides an important reference for the standardized management of asthma .

Objective To study the effect of active cycle of breathing techniques ( ACBT ) on the respiratory function and quality of life in patieats undergoing mechanical ventilation .Methods A total of 65 patients with respiratory failure treated by mechanical ventilation were randomly divided into control group ( n=30) and ACBT group ( n=35) .The patients in ACBT group were treated by ACBT , and the patients in the control group were treated by conventional nursing care .Patients'vital signs , respiratory function and quality of life were compared.The level of physical recovery and quality of life were measured by the scale of the Barthel index and the activities of daily living (ADL), respectively.Results In the ACBT group, the mean time of mechanical ventilation was (24.0 ±8.9) h and the success rate of ventilator weaning was 77.1%, which were better than those of (75.0 ±6.7) h and 53.3%in the control group.There were significant differences between the groups (t=2.73,6.92, respectively;P<0.05).At the first day after ventilation, there was no significant difference in the score of ADL between the groups (P>0.05).But the score of ADL was significantly different at the third day (t=2.85,P<0.05).30.0% patients in the control group and 57.1% patients in the ACBT group had a good viability, the difference was significant (χ2 =6.47,P <0.05).Conclusions The active cycle of breathing techniques was useful in shortening the time of mechanical ventilation and can improve patients 'quality of life.

The revision inincludes both the diagnosis of asthma and the control-based asthma management. It points out that asthma is a heterogeneous disease, and the diagnosis of asthma should be based on the characteristic pattern of symptoms and evidence of variable airflow limitation, emphasizing the diagnosis of atypical asthma. Besides, the epidemiology of asthma, assessment of asthma, management severe asthma, special type of asthma and asthma in special populations have been added in this version. The revised guideline provides an important reference for the standardized management of asthma.
Asthma ; diagnosis ; epidemiology ; prevention & control ; therapy ; Guidelines as Topic ; Humans

Chest tightness variant asthma(CTVA)is an atypical form of asthma with chest tightness as the sole or predominant symptom.The underlying receptors for chest tightness are bronchial C-fibers or rapidly adapting receptors.The nerve impulses are transmitted via the vagus nerve and processed in different regions of the cerebral cortex.Chest tightness is associated with sensory perception,and CTVA patients may have heightened ability to detect subtle changes in lung function,but such sensory perception is unrelated to respiratory muscle activity,lung hyperinflation,or mechanical loading of the respiratory system.Airway inflammation,pulmonary ventilation dysfunction(especially involving small airways),and airway hyperresponsiveness may underlie the sensation of chest tightness.CTVA patients are prone to comorbid anxiety and depression,which share similar central nervous system processing pathways with dyspnea,suggesting a possible neurological basis for the development of CTVA.This article examines the recognition and mechanisms of chest tightness,and explores the pathogenesis of CTVA,focusing on its association with airway inflammation,ventilation dysfunction,airway hyperresponsiveness,and psychosocial factors.

Bronchial asthma is a chronic respiratory disease，characterized by airway inflammation，airway hyperresponsiveness，reversible airway obstruction and airway remodeling，in which a variety of cells including airway inflammatory cells and structural cells are involved. Previous studies have shown that asthma is mainly driven by Th2 cytokines IL-4，IL-5，and IL-13，leading to airway eosinophil inflammation. With further research，however，it has been found that neutrophils are also closely related to asthma. Numbers of neutrophils are elevated in airway through increased chemotaxis and decreased apoptosis，which is earlier than eosinophils，leading to airway neutrophilic inflammation. Neutrophils can produce elastase，myeloperoxidase，neutrophil extra- cellular traps，chemokines and cytokines，participating in the occurrence and development of asthma. The antagonists against these molecules，such as anti-IL-8 receptor antibody，anti-IL-17 antibody，and DNase，have shown positive effects on neutrophilic asthma，but further studies are needed to support their clinical application. This article mainly reviews the role of neutrophils in asthma and related mechanisms.
Asthma/immunology* ; Cytokines ; Eosinophils ; Humans ; Inflammation ; Neutrophils/immunology*