PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
Adrenal Cortex Hormones ; Asthma ; China ; Comorbidity ; Disease Progression ; Education ; Female ; Food Hypersensitivity ; Hospitalization ; Humans ; Hypertension ; Inpatients ; Medication Adherence ; Mortality ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Seasons ; Self Care ; Smoke ; Smoking

Objective To study the inducing factors and clinical characteristics of patients hospitalized for asthma exacerbation in China. Methods Patients hospitalized for asthma exacerbation at 29 hospitals in China were retrospectively recruited during 2013-2014. Results Clinical data of 3 240 asthmatic patients were collected and analyzed including 1 369(42.3%) males and 1 871(57.7%)females. The patients hospitalized for asthma exacerbation counted for 2.95% (6 375/215 955) of all patients hospitalized during the same period. The leading six inducing factors, in sequence, were acute upper respiratory tract infection[42.3%(1 370/3 240)],changes of weather[22.8%(738/3 240)],noxious gas[(4.3% (140/3 240), allergy challenges [3.5%(115/3 240)], strenuous exercise [1.8%(57/3 240)], and air pollution [1.5%(49/3 240)].In older patients,more exacerbations were induced by weather changes,yet less sensitive to allergy challenges. As to middle-aged patients, they were less sensitive to upper respiratory tract infections,however the difference was not statistically significant(P>0.05).In winter more asthma patients were induced by upper respiratory tract infections,while in autumn more patients were induced by weather changes,strenuous exercise and air pollution.In spring and summer more patients were induced by allergy challenges, but the differences failed to achieve statistical significance (P>0.05). In northern cities more patients were induced by upper respiratory infections, whereas in southern cities more by noxious gases. Allergy challenges and air pollution tended to affect more patients in northern cities,but the difference was of no significance (P>0.05). The differences of inducing factors among patients of different gender, with or without a smoking history, and with different exacerbation severity didn't show any statistical significance. The patients with severe and life-threatening exacerbations counted for 20.1%(652/3 240).The percentage of patients older than 60 years was higher in patients with severe or life-threatening exacerbations than in whose with mild or moderate exacerbations,so did the percentage of male patients,of patients with disease duration longer than 10 years, with smoking history, and with a history of hospitalization or emergency department visits due to asthma exacerbation during the last year.Conclusion The acute upper respiratory tract infection ranks top among all the inducing factors. Senility, male gender, long duration of disease, smoking history, and a history of frequent hospital visits might be the risk factors for severe or life-threatening asthma exacerbations.

A novel high performance liquid chromatographic method was developed for the determination of 4-O-methylhonokiol in rabbit plasma and was applied to its pharmacokinetic investigation.Plasma samples were treated by one-fold volume of methanol and acetonitrile to remove the interference proteins.A reverse phase column of SHIMPACK VP-ODS (150 mm× 4.6 mm,5.0 μm) was used to separate 4-O-methylhonokiol in the plasma samples.The detection limit of 4-O-methylhonokiol was 0.2 μg/L and the linear range was 0.012- 1.536 mg/L.The good extraction recoveries were obtained for the spiked samples (84.7％,89.3％ and 87.7％ for low,middle and high concentrations of added standards,respectively).The relative standard deviation of intra-day and inter-day precisions was in the range from 0.6％ to 13.5％.The pharmacokinetic study of 4-O-methylhonokiol was made and the results from the plasmaconcentration curve of 4-O-methylhonokiol showed a two-apartment open model.This work developed a sensitive,stable and rapid HPLC method for the determination of 4-O-methylhonokiol and the developed method has been successfully applied to a pharmacokinetic study of 4-O-methylhonokiol.

A sensitive chemiluminescence(CL) method was developed for determining melamine in urine and plasma samples based on the fact that melamine can remarkably enhance the chemiluminescence of Luminol-K3 Fe(CN)6 system in alkaline medium.The determination conditions were optimized.Under optimum conditions,the chemiluminescence intensity had a good linear relationship with melamine in the range of 9.0 × 10 97.0 × 10 6 g/mL with a correlation coefficient of 0.9992.The detection limits (3σ) were 3.54 ng/mL for urine sample and 6.58 ng/mL for plasma sample.The average recoveries of melamine were 102.6％ for urine sample and 95.1％ for plasma sample.Melamine in samples was extracted with liquid-liquid extraction procedures and the assay results coincided very well with that determined with flow injection chemiluminescence method.The method provides a reproducible and stable approach for sensitive detection and quantification of melamine in urine and plasma samples.

A novel flow injection chemiluminescence（CL）method for the determination of loxoprofen and naproxen was proposed based on the CL system of KMnO4 and Na2SO3 in acid media.The CL intensity of KMnO4-Na2SO3 was greatly enhanced in the presence of loxoprofen and naproxen.The mechanism of the CL reaction was studied by the kinetic process and UV-vis absorption and the conditions were optimized.Under optimized conditions,the CL intensity was linear with loxoprofen and naproxen concentration in the range of 7.0×10^-8-1.0×10^-5g/mL and 2.0×10^-7-4.0×10^-6g/mL with the detection limit of 2.0×10-8g/mL and 3.0×10-8g/mL（S/N=3）,respectively.The relative standard deviations were 2.39% and 1.37% for 5.0×10^-7g/mL naproxen and 5.0×10^-7g/mL loxoprofen（n=10）,respectively.The proposed method was satisfactorily applied to the determination of loxoprofen and naproxen in pharmaceutical preparations.

A novel high performance liquid chromatographic method was developed for the determination of 4-O- methylhonokiol in rabbit plasma and was applied to its pharmacokinetic investigation. Plasma samples were treated by one-fold volume of methanol and acetonitrile to remove the interference proteins. A reverse phase column of SHIM- PACK VP-ODS （150 mm ×4.6 mm, 5.0 μm） was used to separate 4-O-methylhonokiol in the plasma samples. The detection limit of 4-O-methylhonokiol was 0.2 μg/L and the linear range was 0. 012 - 1. 536 mg/L. The good extraction recoveries were obtained for the spiked samples （84.7%, 89.3% and 87.7% for low, middle and high concentrations of added standards, respectively）. The relative standard deviation of intra-day and inter-day precisions was in the range from 0.6% to 13.5%. The pharmacokinetic study of 4-O-methylhonokiol was made and the results from the plasmaconcentration curve of 4-0-methylhonokiol showed a two-apartment open model. This work developed a sensitive, stable and rapid HPLC method for the determination of 4-O-methylhonokiol and the developed method has been successfully applied to a pharmacokinetic study of 4-O-methylhonokiol.

A sensitive chemiluminescence（CL） method was developed for determining melamine in urine and plasma samples based on the fact that melamine can remarkably enhance the chemiluminescence of Luminol-K3 Fe（CN）6 system in alkaline medium. The determination conditions were optimized. Under optimum conditions, the chemiluminescence intensity had a good linear relationship with melamine in the range of 9.0 × 10^-9 - 7.0 × 10^-6 g/mL with a correlation coefficient of 0. 9992. The detection limits （3o） were 3.54 ng/mL for urine sample and 6.58 ng/mL for plasma sample. The average recoveries of melamine were 102.6% for urine sample and 95.1% for plasma sample. Melamine in samples was extracted with liquid-liquid extraction procedures and the assay results coincided very well with that determined with flow injection chemiluminescence method. The method provides a reproducible and stable approach for sensitive detection and quantification of melamine in urine and plasma samples.

A novel flow injection chemiluminescence (CL) method for the determination of loxoprofen and naproxen was proposed based on the CL system of KMnO4 and Na2 SO3 in acid media.The CL intensity of KMnO4-Na2 SO3 was greatly enhanced in the presence of loxoprofen and naproxen.The mechanism of the CL reaction was studied by the kinetic process and UV-vis absorption and the conditions were optimized.Under optimized conditions,the CL intensity was linear with loxoprofen and naproxen concentration in the range of 7.0 × 10- 8 - 1.0 × 10 5 g/mL and 2.0 × 10 7 - 4.0 × 10 6 g/mL with the detection limit of 2.0 × 10 8g/mL and 3.0 × 10 sg/mL (S/N =3),respectively.The relative standard deviations were 2.39％ and 1.37％ for 5.0 × 10- 7 g/mL naproxen and 5.0 × 10 7 g/mL loxoprofen ( n =10),respectively.The proposed method was satisfactorily applied to the determination of loxoprofen and naproxen in pharmaceutical preparations.

Objective To establish a rapid, accurate and sensitive chemiluminescence method for determining sulfydryl-containing drugs. Methods In sulfuric acid solution, glyoxal could be oxidized by potassium permanganate, and weak chemiluminescence could be observed. Chemiluminescence signal could be enhanced in the presence of sulfydryl-containing drugs. Thus, on this basis we established a new method of determining the concentration of sulfydryl-containing drugs with flow injection chemiluminescence analysis. Results Under the optimized conditions, the linear range of methimazole, captopril and acetylcysteine was 1.0×10~(-8)- 5.0×10~(-6), 7.0×10~(-8)-1.0×10~(-6) and 3.0×10~(-8)-1.0×10~(-6)g/mL, respectively. The limit of detection of methimazole, captopril and acetylcysteine was 1.0, 3.9 and 3.7ng/mL, respectively. Conclusion The method was successfully applied to determine the three drugs that contain sulfydryl. Compared with the results of pharmacopeia methods, the results we obtained were satisfactory.

Objective To develop a rapid, simple and sensitive chemiluminescence method for the determination of three β-blockers (bisoprolol, atenolol and propranolol). Methods The chemiluminescence of cerium (Ⅳ)-sulfite system was obviously sensitized by adding anyone of three β-blockers in acid media. A new chemiluminescence method was set up by combining with flow-injection technique and used to determine the three β-blockers. Results Good linear ranges were obtained at the concentrations of 2.0×10-7g/mL-4.0×10-5g/mL, 1.0×10-7g/mL-3.0×10-5g/mL and 7.0×10-7g/mL-1.0×10-5g/mL, respectively, with the detection limits of 5.0×10-8g/mL, 7.0×10-8g/mL and 5.0×10-8g/mL (S/N=3), respectively, and the relative standard deviations for 11 times consecutive injections of 1.0×10-6g/mL bisoprolol, atenolol and propranolol were 3.57%, 2.21% and 2.26%, respectively. Conclusion The developed method is sensitive, accurate, rapid and of low cost. And it can be applied to determine bisoprolol, atenolol and propranolol in pharmaceutical preparations.