大环内酯类药物的抗菌外作用与临床应用专家共识

Important/potential value of macrolides has been proved in the management of chronic respiratory diseases by increasing basic and clinical trials.Through three face-to-face discussions,10 experts examined important data and drafted this consensus related to macrolides:(1) mechanism of nonantiinfective effects;(2) clinical use in chronic respiratory diseases;(3) cautions of long-term use.The mechanism out of non-antiinfective effects includes anti-inflammatory effect,modifying airway secretion,immune-regulation related to antibacterial effect,corticoid saving effect and anti-viral effect.The efficacy of long-term use of low-dose macrolides is definitely confirmed in diffuse panbronchiolitis,chronic rhinosinusitis.It is considerably used in bronchiectasia,cystic fibrosis,severe asthma and chronic obstructive pulmonary disease.Further studies should be conducted in cryptogenic organizing pneumonia and respiratory viral infection.It should be paid attention to its possible adverse effects (including drug interactions,cardiac toxicity,ototoxicity and disturbance of intestinal flora) and drug resistance in long-term use.A Chinese consensus for non-antiinfective effects and clinical use of macrolides is developed for the first time,which aims to expand their rational use and the further research.

支气管哮喘急性发作评估及处理中国专家共识

Asthma exacerbations can do a lot of harm to the patients and consume large amounts of medical resources. This consensus is based on the domestic and foreign guidelines and literatures to standardize the evaluation and management of asthma exacerbations in China. Asthma exacerbations are characterized by a progressive increase in symptoms of shortness of breath, cough, wheezing or chest tightness and progressive decrease in lung function,and usually require modification of treatment.Recognizing risk factors and triggering factors of asthma exacerbations is helpful for the prevention and long-term management. Evaluation of asthma exacerbations is based on symptoms, lung function, and arterial blood gas. Management is stratified according to the severity of disease. Different regimens to treat asthma exacerbations are discussed in this consensus. Glucocorticoids should be used properly. Overuse of antibiotics should be avoided. Management of life-threatening asthma is discussed separately. Special attention should be paid in some special respects, such as asthma during peri-operation period, gestation period, and childhood. Diagnosis and management of complications are also of great significance and are discussed in details.

Objective: To assess the haematological and lipid profile assays in asthmatics. Methods: Eighty asthmatic subjects were prospectively studied in a major referral centre serving the Niger Delta region of Nigeria for 12 months (2006-2007). Clinico-haematological and serum lipid total cholesterol (TC), triglyceride (TG), and lipoproteins concentration were analyzed after adjusting for age, cigarette smoking, alcohol ingestion, hypertension and diabetes mellitus. Results: Eighty patients (34 males and 46 females) were seen with female predominating in the various age groups (M∶ F ratio, 0.7∶ 1). Total cholesterol and low density lipoproteins-cholesterol for the asthmatics was significantly higher than the controls (P<0.000 1), while the ratio of TC∶ HDL-C(high density lipoprotein-cholesterol) in asthmatics was 3.67 compared to the control value of 3.01. TC and low density lipoprotein-cholesterole( LDL-C) were significantly higher in females than the males (P<0.05). There was a combined hypertriglyceridemia (HT, >2.3mmol/L) and a significant hypercholesterolemia (HC, >5.2mmol/L) according to the Adult Treatment Panel III definition in asthmatics thereby putting them at increased risk for the development of cardiovascular disease as well as other disorders related to excess lipids. There was a significant thrombocytopenia (P<0.000 1) which may accompany allergen exposure and this persists for 24 h; that asthmatics of African descent showed a significantly increased total leucocyte count (P=0.001) similar to other studies in the Western countries. Conclusion: Hyperlipidaemia is a prevalent medical problem among asthmatics; hence screening for fasting serum lipid levels to identify those who need early intervention is recommended.

Background: Continuous beta-agonist therapy, typically in the form of inhaled albuterol, is the first line therapy for the treatment of acute and severe bronchospasm in children. Although this treatment is commonly used, concerns about cardiotoxicity have been raised. We aimed to investigate the cardiotoxic effects of continuous beta-agonist therapy in children.
Methods: We conducted a retrospective review of children admitted to the intensive care unit (ICU) between May 2008 and April 2009, who were treated with continuous beta-agonist therapy (intravenous and nebulized).
Results: Twenty of the 36 children treated with continuous albuterol had repeated serum troponin-T and lactate levels measured. Eleven patients (55%) were also treated with continuous intravenous terbutaline. Elevated levels of troponin-T levels were found in 25% of children, and elevated lactate levels were found in 60%. However, all returned to normal levels within 48 hours of ICU admission, despite continued beta-agonist therapy. No children experienced arrhythmias during therapy. There was no association between intravenous terbutaline use and elevated troponin-T [odds ratio (OR), 1.3; 95% CI, 0.2-10.3] or with elevated serum lactate (OR, 0.6; 95% CI, 0.1-3.7). There was also no association between elevated troponin-T or lactate and ICU or hospital length of stay.
Conclusions: In this small study, a significant proportion of children had elevated serum troponin-T and lactate levels while receiving inhaled continuous beta-agonist therapy, irrespective of intravenous therapy. However, these abnormal values all returned to normal within 48 hours of ICU admission and were not associated with increased duration of hospitalization.