Objective To explore influencing factors for disease control in children with bronchial asthma treated by budesonide formoterol inhalant.Methods Clinical data of 80 children with bronchial asthma admitted to Suqian First Hospital from January 2019 to January 2022 were retrospectively analyzed.All the children were treated with budesonide formoterol inhalant.The disease control level was evaluated by the childhood asthma control test questionnaire after 12-week treatment.According to the scores,the children were divided into complete control group(>25,33 cases),partial control group(22-25,35 cases)and uncontrolled group(<22,12 cases).The gender,age,body mass index(BMI),positive result of allergen skin prick test(SPT),severity of illness,allergic constitution,educational level of the family,family history of asthma,and the percentage of forced expiratory volume in one second in estimated value(FEV1%pred)were compared among groups.Multivariate Logistic regression analysis was used to identify independent risk factors for poor disease control in children with bronchial asthma treated by budesonide formoterol inhalant.Results There were significant differences among the three groups in the severity of illness,allergic constitution,and FEV1%pred(P<0.05).Multivariate Logistic regression analysis confirmed that moderate to severe disease severity,allergic constitution and FEV1%pred≤82.695%were independent risk factors for poor disease control in children with bronchial asthma treated by budesonide formoterol inhalant.(P<0.05).Conclusion Moderate to severe disease severity,allergic constitution and FEV1%pred≤82.695%are risk factors for poor disease control in children with bronchial asthma treated by budesonide formoterol inhalant.Different interventions should be given according to different conditions so as to improve disease control in children with bronchial asthma.

Apoptosis ; Autophagy ; Ferroptosis ; Iron/metabolism* ; Sequestosome-1 Protein/metabolism* ; Ubiquitin-Specific Proteases/metabolism*

Allopurinol is an inhibitor of xanthine oxidase,which is used for the treatment of gout and hyperuricemia by inhibiting uric acid synthesis thereby reducing uric acid. Allopurinol can cause severe cutaneous adverse reactions(SCAR),including drug hypersensitivity syndrome,Stevens-Johnson syn-drome (SJS),and toxic epidermal necrolysis(TEN). The study on the correlation between HLA-B*58:01 alleles and allopurinol-induced SCAR in different racial groups showed that there was a strong correlation between HLA-B*58:01 alleles and allopurinol-induced SCAR in Taiwan,Hong Kong,and the mainland of China, as well as in Thailand,Korea with high frequency of HLA-B*58: 01,while there was also an significant correlation between them in Japan and Europe with low frequency of HLA-B*58:01. Presently,there have been few studies on the specific mechanism of HLA-B*58: 01 alleles in the process of the allopurinol-induced SCAR. Representative research found that allopurinol and its metabolite oxypurinol directly and immediately activates the drug-specific T cells by bounding to HLA-B*58: 01 through the mechanism of pharmacological interaction with immune receptors,afterwards leading to SCAR.

A 32-year-old female patient with hyperthyroidism received methimazole 10 mg orally thrice daily.Three weeks later,she developed fatigue,anorexia,deep-colored urine,and pruritus of whole body skin.Methimazole was stopped.Laboratory tests showed the total bilirubin (TBil) of 463.1 μmol/L,bilirubin direct (DBil) of 348.9 μmol/L,alanine aminotransferase (ALT) of 142 U/L,aspartate aminotransferase (AST) of 64 U/L,and alkaline phosphatase (ALP) of 499 U/L.Cholestatic hepatitis induced by methimazole was considered.The patient received IV infusion of reduced glutathione,polyene phosphatidylcholine,hepatocyte growth-promoting factors,alprostadil,adenosylmethionine 1,4-butanedisulfonate,and methylprednisolone sodium succinate,and oral ursodeoxycholic acid capsules.Thirteen days later,the laboratory tests showed TBil of 432.3 μmol/L,DBil of 260.6 μmol/L,and total bile acid (TBA) of 564.0 μmol/L.The patient received 4 times of plasmapheresis within 8 days because her pruritus was not improved.On day 3 after the last plasmapheresis,laboratory tests showed TBil of 271.3 μmoL/L,DBil of 175.3 μmol/L,and TBA of 483.0 μmol/L.Liver-protective drugs and medications used to treat jaundice were continued.On day 47 after the last plasmapheresis,laboratory tests showed TBil of 22.4 μmol/L,DBil of 8.3 μmol/L,ALT of 35 U/L,AST of 20 U/L,ALP of 114 U/L,and TBA of 47.0 μmol/L.On day 51 after the last plasmapheresis,her pruritus and yellowish skin and sclera disappeared,her urine color returned to normal,and her physical strength recovered.

Allopurinol is an inhibitor of xanthine oxidase,which is used for the treatment of gout and hyperuricemia by inhibiting uric acid synthesis thereby reducing uric acid. Allopurinol can cause severe cutaneous adverse reactions(SCAR),including drug hypersensitivity syndrome,Stevens-Johnson syn-drome (SJS),and toxic epidermal necrolysis(TEN). The study on the correlation between HLA-B*58:01 alleles and allopurinol-induced SCAR in different racial groups showed that there was a strong correlation between HLA-B*58:01 alleles and allopurinol-induced SCAR in Taiwan,Hong Kong,and the mainland of China, as well as in Thailand,Korea with high frequency of HLA-B*58: 01,while there was also an significant correlation between them in Japan and Europe with low frequency of HLA-B*58:01. Presently,there have been few studies on the specific mechanism of HLA-B*58: 01 alleles in the process of the allopurinol-induced SCAR. Representative research found that allopurinol and its metabolite oxypurinol directly and immediately activates the drug-specific T cells by bounding to HLA-B*58: 01 through the mechanism of pharmacological interaction with immune receptors,afterwards leading to SCAR.

A 32-year-old female patient with hyperthyroidism received methimazole 10 mg orally thrice daily.Three weeks later,she developed fatigue,anorexia,deep-colored urine,and pruritus of whole body skin.Methimazole was stopped.Laboratory tests showed the total bilirubin (TBil) of 463.1 μmol/L,bilirubin direct (DBil) of 348.9 μmol/L,alanine aminotransferase (ALT) of 142 U/L,aspartate aminotransferase (AST) of 64 U/L,and alkaline phosphatase (ALP) of 499 U/L.Cholestatic hepatitis induced by methimazole was considered.The patient received IV infusion of reduced glutathione,polyene phosphatidylcholine,hepatocyte growth-promoting factors,alprostadil,adenosylmethionine 1,4-butanedisulfonate,and methylprednisolone sodium succinate,and oral ursodeoxycholic acid capsules.Thirteen days later,the laboratory tests showed TBil of 432.3 μmol/L,DBil of 260.6 μmol/L,and total bile acid (TBA) of 564.0 μmol/L.The patient received 4 times of plasmapheresis within 8 days because her pruritus was not improved.On day 3 after the last plasmapheresis,laboratory tests showed TBil of 271.3 μmoL/L,DBil of 175.3 μmol/L,and TBA of 483.0 μmol/L.Liver-protective drugs and medications used to treat jaundice were continued.On day 47 after the last plasmapheresis,laboratory tests showed TBil of 22.4 μmol/L,DBil of 8.3 μmol/L,ALT of 35 U/L,AST of 20 U/L,ALP of 114 U/L,and TBA of 47.0 μmol/L.On day 51 after the last plasmapheresis,her pruritus and yellowish skin and sclera disappeared,her urine color returned to normal,and her physical strength recovered.

A 70-year-old male patient received ticagrelor 90 mg twice daily and aspirin 100 mg once daily as dual antiplatelet therapy after operation for coronary stent implanting. On day 2 of treatment,he developed traces of blood in sputum. The hemoptysis became worse and times became more after that. On day 42,the patient developed massive hemoptysis about 100 ml. Ticagrelor was discontinued by himself. The patient then was given oxygen inhalation,expectorant drug and hemostatic agents. Anticoagulant therapy was adjusted for the combined use of clopidogrel 75 mg once daily and aspirin 100 mg once daily. On day 4 of the ticagrelor withdrawal,the amount of hemoptysis was obviously reduced. On day 7,the hemoptysis ceased.

A 70-year-old male patient received ticagrelor 90 mg twice daily and aspirin 100 mg once daily as dual antiplatelet therapy after operation for coronary stent implanting. On day 2 of treatment,he developed traces of blood in sputum. The hemoptysis became worse and times became more after that. On day 42,the patient developed massive hemoptysis about 100 ml. Ticagrelor was discontinued by himself. The patient then was given oxygen inhalation,expectorant drug and hemostatic agents. Anticoagulant therapy was adjusted for the combined use of clopidogrel 75 mg once daily and aspirin 100 mg once daily. On day 4 of the ticagrelor withdrawal,the amount of hemoptysis was obviously reduced. On day 7,the hemoptysis ceased.