针刺对支气管哮喘患者临床症状与肺功能的影响

目的：探讨针刺治疗支气管哮喘（简称哮喘）的临床疗效。方法：104例慢性持续期、缓解期哮喘患者，采用分层随机对照法分为治疗组和对照组。治疗组在应用抗哮喘药物的同时，取曲池、列缺、鱼际、内关、足三里、三阴交、太溪穴针刺治疗，每日1次，10次为一疗程；对照组单独应用抗哮喘药物，观察治疗前后哮喘患者临床症状与肺功能的改变。结果：治疗组患者的哮喘症状评分值降低，肺部哮鸣音减少，病情严重程度及分级明显改善，与对照组比较差异均有显著性意义（均P〈0．05）}同时，第1秒用力呼气容积（FEV1）、呼气峰流速（PEF）、用力呼气流速（FEF）各阶段[FEF25％-75％（％PRED）、FEF75％-85％]、最大呼气流量50％与75％占预计值百分数[FEF50％（％PRED）、FEF75％（％PRED）]等治疗组均较对照组显著改善（P〈0．05，P〈0．01，P〈0．001）。6个月后远期观察结果表明，哮喘急性发作率治疗组显著低于对照组（P〈0．05）。同时，针刺治疗组50％患者减少抗哮喘药物剂量1／3～1／4。结论：针刺治疗可显著改善哮喘患者的临床症状，提高肺功能，具有一定的远期疗效。

Respiratory Distress Resulting from Gastroesophageal Reflux Is not Asthma,but Laryngotracheal Irritation,Spasm,even Suffocation

ESPITE the strong association between gastroesophageal reflux disease （GERD） and asthma has been undisputedly established and widely recognized by experts in advanced countries. Yet few topics in medicine are as controversial as the causal relationship between GERD and asthma： some argue that GERD causes asthma, while others think the other way around is true, still quite a few believe that bronchodilator medications are to blame. This controversy continues to be a conundrum or more piece of the puzzle.1 We would like to share two thoughts which might be a belated revelation with scholars and experts and invite them for further cooperative studies： the GERD-derived respiratory distress is not asthma, but GERD pure and simple; and the pathogenesis of respiratory distress is not asthma, but laryngotracheal irritation/spasm/suffocation.

Remission of bronchial asthma after viral clearance in chronic hepatitis C

A 53-year-old man with a history of blood transfusion at the age of 20 was admitted to our hospital because of liver dysfunction. He had bronchial asthma when he was 18 years old, which naturally resolved within 2 years. However, his bronchial asthma recurred at the age of 45 and was treated with oral theophylline. He was diagnosed as having chronic hepatitis C based on the histological and clinical findings, and then interferon (IFN) therapy was administered. The frequency of bronchial asthma attack was gradually decreasing after IFN therapy with marked improvement of hypereosinophilia. He achieved sustained viral response (SVR) and his bronchial asthma did not worsen even after the cessation of IFN. Hepatitis C virus (HCV) infection and IFN therapy were considered in the remission of asthma in this case. HCV infection could be the cause of bronchial asthma, especially in patients with late appearance of asthma.

CIRCULATING INTERCELLULAR ADHESION MOLECULE 1 LEVELS IN SERA OF BRONCHIAL ASTHMA

Objective The aim of the study was to determine whether bronchial asthma was associated with increased levels of soluble intercellular adhesion molecule 1(sICAM 1) in serum, which might be valuble data for the effective therapy of these patients Patients and methods The concentrations of sICAM 1 were determined in sera of healthy donors and asthmatic patients using a sensitive enzyme immunoassay Results The mean(±SD) levels of serum sICAM 1 of 26 asthmatic patients (205±72 0 μg/L)was significantly higher than that of the 30 healthy volunteers (154±63 9 μg/L,P<0 01) There was no much difference between the serum levels in 12 patients suffering from atopic asthma and the levels in 14 patients with nonatopic asthma The serum concentrations of sICAM 1 were higher during asthma attacks than that during remissions in the same patients (P<0 05) Conclusion These results suggest that sICAM 1 may play a certain role in the pathophysiology of bronchial asthma,and might be signals for successful treatment

Association of Xenobiotic Detoxification Enzymes Gene Polymorphism in Predisposition of Bronchial Asthma and Chronic Obstructive Pulmonary Disease

Glutathione-S-transferase （GST） family enzymes are implicated in the pathopbysiology of bronchial asthma （BA） and chronic obstructive pulmonary disease （COPD）. In some cases both illnesses exhibit similar pathomorphologic and clinical features, indicating common genetic basis of predisposing to development of disease. To assess genetic susceptibility we conducted association analysis of glutathione-S-transferases Mu （M）, Theta （T） and Pi （P） gene polymorphism with disease development in 85 adult asthma, 60 COPD subjects and 64 control subjects. Present investigation of GST gene polymorphisms indicates that GSTM1 and GSTT null alleles are associated with predisposition for COPD and they do not appear to play a substantial role in susceptibility to BA. However, homozygote ＋/＋ and heterozygote ＋/0 genotypes of GSTT1 revealed to be associated with increasing of IgE level in serum in BA patients. Our findings suggest that the 105 Val variant of GSTP1 contributed to the increasing risk of developing of both diseases, and more likely for COPD.

DEVELOPMENT OF RESEARCHES ON THE TREATMENT OF BRONCHIAL ASTHMA WITH ACUPUNCTURE AND MOXIBUSTION

Acu-moxibustion therapy is one of the commonly-used remedies for the prevention and treatmerit of asthma. In the present article, the authors review development of clinical studies on acu-moxibustion treatment of asthma in recent 5 years from ① changes of pulmonary function as forced expiratory volume in 1 second （FEV1）, forced vital capacity （FVC）, FEV1%, peak expiratory flow （PEF）, maximum mid expiratory flow （MMEF）, etc., ② changes of immune function as serum IgE, IgG, subgroups of T lymphocytes, inflammatory mediators, cytokines, etc, and ③ changes of the nervous system and related receptors including nitric oxide （NO）, vasoactive intestinal peptide （VIP）, substance P （SP）, and cAMP/cGMP. Additionally, the authors also introduce the development of experimental researches from the effects of acu-moxibustion on ① inflammatory cells, ② nervous system and receptors, ③ patho-morphological changes of the lung tissue, and ④serology of acupuncture.

CLINICAL OBSERVATION ON TREATMENT OF ALLERGIC BRONCHIAL ASTHMA WITH ACUPOINT APPLICATION THERAPY

In the present paper, the therapeutic effect of acupoint application of Chinese Materia Medica in the treatment of allergic asthma was observed. The results revealed that topical application of drug paste [mixture of powder of Mahuang (Herba Ephedrae), Xixin (Herba Asari), Baijiezi (Semen Sinapis Albae), etc.] at the acupuncture points could improve symptoms and signs of allergic asthma patients, with the total effective rate being 69.57% (16/23) for the short term effect, and 52.17%(12/23) for the long term effect. In medication (Aminophylline) group, of the 25 cases of allergic asthma, 16 (64.0%) were effective after 4 weeks of treatment, while 6 (24.0%) were still effective that was shown by 6 months’ follow up. The therapeutic effect of acupoint application group was significantly better than that of medication group in the long term effect. Results also showed that no obvious interrelation between the short term therapeutic effect and the duration or the severity of the disease. Results also display that acupoint application therapy is an effective, safe and handy method with fewer side effects for asthma.

MEDICINAL VESICULATION THERAPY AND ITS CLINICAL APPLICATION

In this paper, the authors introduce medicinal vesiculation therapy from its origin, points for attention in clinical application, and their individual experiences. In clinical application, the authors advocate: ① avoid using drugs that are over-irritating in the property, and strictly controlling the dose of drugs and the duration of application, ② in selection of drugs, some factors as patients’ conditions, the season, the geographic location, etc. should be taken into account. In the present paper, 3 typical cases of bronchial asthma, tonsil swelling and facial paralysis treated with medicinal vesiculation therapy are introduced. Clinical practice demonstrates that this therapy is economical, simple and convenient and fairly effective in treatment of some chronic diseases.

Role of β-adrenoceptor at different stages of bronchial asthma

Objective To investigate the changes of β-adrenergic receptor (βAR) in peripheral lymphocytes and β2AR mRNA levels at different stages of bronchial asthma. Methods β2AR density and β2AR mRNA level in peripheral lymphocytes, cAMP and cGMP levels in blood plasma were estimated by radioligand binding assay, radioimmunoassay and RT-PCR.Results (1) Maximum bound volume (Bmax) and equilibrium dissociation constant (Kd) of β2AR of lymphocyte in asthma patients at remission stage were markedly higher than that in normal subjects, while cAMP levels in blood plasma showed no difference. Bmax of β2AR and cAMP levels in asthma patients at acute exacerbation stage were significantly lower than that in normal subjects, and Kds between these two groups were not much different. (2) Expression of β2ARmRNA in peripheral lymphocytes of asthmatics at remission stage was not significantly different compared with that in normals. Conclusions Amount and function of βAR and β2ARmRNA levels are related to asthmatic conditions. Changes of βAR and β2ARmRNA in asthma might rather be a pathological change accompanied by the course of the disease than a primary defect.

Analysis of the T cell receptor Vδ region gene repertoire in bronchoalveolar lavage fluid (BALF) and peripheral blood of asthmatics

Objective To explore the role of γδT cells in the airway of asthmatics and to identify the forces which induce and maintain the inflammatory processMethods Peripheral blood (PB) and bronchoalveolar lavage fluid (BALF) were obtained from7 asthmatic subjects and 7 nonsmoker control subjects The percentage of γδT cells in the PB and BALF was measured by immunofluorescent staining and flow cytometry The frequency of usage and the clonality of Vδ subfamilies (Vδ 1-Vδ 3) were assessed by RTPCR and gene scanning Results A higher proportion of γδT cell was detected in the BALF of asthmatic subjects (7.8%±4.7%) than that from control subjects (3.3%±3.0%, P=0.04) No selective usage for a particular Vδ subfamily was found, but the relative expression level of Vδ 1 was significantly higher in the asthmatic airway (44%±13%) than in the control (19%±5%, P=0.0002) In asthmatic subjects, the monoclonal or oligoclonal expansion of γδT lymphocytes was predominant in the BALF, especially Vδ 1+ T lymphocytes Conclusions Antigenic specific γδT cells might play an important role in the inducement and maintenance of airway inflammation Persistent antigenic stimulation may be the key factor that maintains chronic airway inflammation in asthma

Cloning and polymorphism analysis of IL-4 proximal promoter in asthmatic children

OBJECTIVE: To clone and study the polymorphism within interleukin-4 (IL-4) proximal promoter of asthmatic children. METHODS: The IL-4 proximal promoter segments were amplified and selected by polymerase chain reaction (PCR) and single strand conformation polymorphism (SSCP) with genomic DNA from ten healthy children and forty patients with dominantly allergic familial histories as templates. The selected PCR segments were cloned into recombinant plasmids pIL-4-Jx2. The PCR inserts were sequenced by dideoxy chain termination method. RESULTS: Seven aberrant bands were found in SSCP analysis from forty asthmatic patients. The sequencing results showed that four variant sites were found within or adjacent to the known IL-4 regulatory element. A C to A transversion located at -229 position was just within the positive regulatory element-I (PRE-I) in one patient. A C to T transition adjacent to the negative regulatory element-II (NRE-II) and an extra G adjacent to TATA box were found in two patients. A five base nucleotide deletion was found near signal transducers and activators of transcription-6 responsive element (STAT-6 RE) in one patient. CONCLUSION: There were polymorphisms within the IL-4 proximal promoter of allergic asthmatic patients and these polymorphisms might result in aberrant expression of IL-4 gene and asthma.

Nuclear factor-κB in signal conduction of protein kinase C in T lymphocytes from an asthmatic guinea pig model

Objective To explore the role of nuclear factor κB (NF κB) in the signal conduction of protein kinase C (PKC) regulated proliferation, apoptosis and expression of Th2 cytokines - interleukin 4 (IL 4) and interleukin 5 (IL 5) of T lymphocytes in the bronchial alveolus lavage fluid (BALF) Methods T lymphocytes were isolated and purified from BALF of asthmatic guinea pigs in normal and asthmatic groups, and were stimulated with PKC agitator phorbol 12 myristate 13 acetate (PMA) and NF κB inhibitor pyrrolidine dithiocarbamate (PDTC), respectively The expressions of NF κB, IL 4 and IL 5 mRNA and protein, the proliferation and apoptosis of T lymphocytes were observed by immunohistochemistry, in situ hybridization, ELISA, MTT and TUNEL, respectively Results The activation of NF κB, proliferation response, and expression of IL 4 and IL 5 mRNA and protein in T lymphocytes stimulated by PMA were significantly higher than those of their blank control ( P 【0 01), while those indexes of T lymphocytes stimulated by PMA and PDTC simultaneously were significantly lower than those stimulated by PMA alone ( P 【0 01) The apoptotic index of T lymphocytes stimulated with PMA were significantly lower than that of their blank control ( P 【0 01), and the apoptotic index of asthmatic guinea pig T lymphocytes stimulated with PMA and PDTC simultaneously were significantly higher than that stimulated by PMA alone ( P 【0 01) The significant positive correlations were found between the activation of NF κB and the proliferation ( r =0 64, P 【0 001), and the expression of IL 4 and IL 5 mRNA and protein of T lymphocytes, respectively ( r =0 55-0 68, P 【0 001) There was also significant negative correlation between the activation of NF κB and apoptosis of T lymphocytes ( r =0 62, P 【0 001) Conclusions NF κB may participate in the signal conduction of PKC regulated proliferation, apoptosis and expression of IL 4 and IL 5 of T lymphocytes in asthma The activation of NF κB in PKC signal conduction pathway of T lymphocytes may play an important role in the pathogenesis of asthma

Clinical research of acupoint application for "treatment of winterdisease in summer" used to prevent and treat bronchial asthma inchildren

OBJECTIVE:To preliminarily analyze key factors influencing curative effect through clinical observations of acupoint application for "treatment of win-ter disease in summer" used to prevent and treat bronchial asthma in children.METHODS:In an observational study and prospective cohort study,we observed children in remission of asthma at three class Ⅲ grade A TCM hospitals in Liaoning,Hubei,and Chengdu.RESULTS:A total of 609 children conformed to diagnostic and inclusive standards for remission of bronchial asthma.Through follow-up visits,we observed their skin reactions and the time and chance of treatment with different therapies in the three hospitals;we also compared and analyzed different drugs,acupoints,and preparations.We found that the key Chinese drugs were Bai Jie Zi(Semen Sinapis Albae) and Yian Hu Suo(Rhizoma Corydalis);the key acupoints were Feishu(BL 13),Gaohuang(BL 43),Dingchuan(EX-B1),Tiantu(CV 22),and Shanzhong(CV 17);and the best preparation was a mixture of drugs,ginger juice,and musk.Acupoint application was practiced on the hottest days of summer and the coldest days of winter for 0.5 to 2 h with the lowest rate of asthma relapse.CONCLUSIONS:The present data analysis shows that the curative effect of acupoint application for "treatment of winter disease in summer" may be influenced by recipes of Chinese drugs,preparations,prescriptions of acupoints,chance,time,and skin reactions.A curative effect is the result of the comprehensive action of these factors.

Systematic review of randomized controlled trials of traditional Chinese medicine treatment of non-acute bronchial asthma complicated by gastroesophageal reflux

OBJECTIVE:To assess the effectiveness and safety of Traditional Chinese Medicine(TCM) treatment of non-acute bronchial asthma complicated by gastroesophageal reflux.METHODS:We searched databases from MEDLINE,Cochrane Library,CNKI,VIP,CBM,Wanfang Data,and TCM Database Systems.All randomized,controlled trials(RTCs) of TCM treatment of non-acute asthma complicated by gastroesophageal reflux were included.Data were independently collected by two reviewers.The standards for assessing quality described in the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate articles.Meta-analyses were conducted using RevMan 5.0.17 software.Heterogeneity was assessed,and a corresponding effects model was used to merge and analyze results.Indexes used to evalu-ate curative effects were:clinical efficacy,symptom scores,pulmonary function values,and adverse incidents.Effectiveness was indicated using risk ratio(RR) or mean difference(MD),and 95% confidence intervals(CIs) were calculated.RESULTS:Six RCTs were included,involving 304 patients with non-acute asthma complicated by gastroesophageal reflux.The treatment groups received Chinese drugs alone or TCM combined with standard Western medical treatment,and the control groups received standard Western medical treatment alone.Standard Western medical treatment included anti-inflammatory drugs and bronchodilators for asthma,and drugs to promote gastric peristalsis and inhibit gastric acid production for gastroesophageal reflux.Methodological quality was low in all six RCTs.Two RCTs showed that clinical efficacy was higher in the treatment group than in the control group(RR:1.43,95%CI:1.10 to 1.87 vs RR:1.51,95% CI:1.09 to 2.08).One RCT showed that the asthma score was lowered more effectively in the treatment group than in the control group(MD:-1.10,95% CI:-2.04 to-0.16).Two RCTs showed that the gastroesophageal reflux score was reduced more effectively in the treatment group than in the control group(RR:-3.70,95% CI:-4.30 to 3.10 vs RR:-5.30,95% CI:-6.32 to-4.28).One RCT showed that some pulmonary function values were improved more effectively in the treatment group than in the control group(P< 0.05).No differences were seen in the various indexes between groups in the other RCTs.No adverse reactions,dropout rates,or follow-up rates were reported in any of the RCTs.CONCLUSIONS:The clinical symptoms ofnon-acute asthma complicated by gastroesophageal reflux can be improved by some Chinese drugs.Curative effects can be increased by combining the use of TCM with Western medicine.Because of the small quantity and low quality of research reported to date,it is necessary to conduct further RCTs to confirm these results.The results of this systematic review indicate that the quality of future clinical trials should be improved by including larger patient numbers,correctly randomizing patients into study groups,using blinding methods to measure and assess outcomes,and using accepted indexes to evaluate curative effects.

Effect of “three-acupoint and five-needling method” on the expression level of p-ERK 1/2 protein in lung tissue of rats with allergic bronchial asthma

Objective To explore the effect of ＂three-acupoint and five-needling method＂ on the expression level of p-ERK 1/2 protein in lung tissue of rats with allergic bronchial asthma.Methods Forty SPF-grade male SD rats were selected and randomly divided into four groups,including control group（group C）,model group（group M）,acupuncture group（group A） and blocker group（group PD）,with 10 rats in each group.After corresponding intervention was given,cell counting was conducted,and the expression level of p-ERK 1/2 protein in the lung tissue of rats was detected via immunohistochemical method and Western blot method.Results The number of leukocyte and eosinophil in the bronchoalveolar lavage fluid of rats in group A and group PD was smaller than that in group M,but larger than that in group C.It was shown based on the immunohistochemical test and Western blot test that the expression level of p-ERK1/2 protein in the lung tissue of rats in group M was higher than that in group C（P0.05）,while the expression level of p-ERK1/2 protein in group A and group PD was lower than that in group M（P0.05）.Conclusion ＂Threeacupoint and five-needling method＂ can effectively relieve the inflammatory response of rats with allergic bronchial asthma,and inhibit the expression level of p-ERK 1/2 protein in the lung tissue of rats with asthma.Acupuncture may alleviate the symptom of allergic bronchial asthma through inhibiting the expression level of p-ERK 1/2 protein.

Effectiveness and safety of heat-sensitive moxibustion on bronchial asthma:a Meta-analysis of randomized control trials

OBJECTIVE: To systematically evaluate the effectiveness and safety of heat-sensitive moxibustion(HSM)onasthma.METHODS: Large databases in China and overseas were searched by electronic and manual means to collect information on randomized controlled trials(RCTs).Two evaluators independently extracted data and evaluated the quality of RCTs according to Cochrane Review Handbook v5.0. RevMan v5.0.20 was used for statisticalanalyses.RESULTS: Fourteen RCTs involving 637 patients were collected.Thirteen RCTs compared the effects of HSM and Western Medicine. After 3-month treatment and after 6-month follow-up, there was no significant difference in effective rate [relative risk(RR)=1.01, 95% CI(0.92, 1.12), and 1.12,(0.93, 1.36),respectively], in the asthma control test score of asthma symptoms [weighted mean difference(WMD)=﹣1.54, 95% CI(﹣3.54, 0.47), and 1.41,(﹣0.48, 3.29), respectively] and in the forced expiratory volumein 1 second(FEV1)and peak expiratory flow(PEF). One RCT compared the effect of HSM with warm-suspended moxibustion. After 6-month follow-up, there was a significant difference in FEV1 and PEF [WMD=0.51, 95% CI(0.10, 0.92), and 1.78,(1.06, 2.50), respectively]. After 3-month treatment,there was no significant difference between the two groups. One RCT compared the effect of HSM with acupoint application. After 3-month treatment, there was no significant difference in the effectiverate[RR=0.68,95%CI(0.42,1.12)].CONCLUSION: HSM did not show superiority to conventional Western Medicine and acupoint application in terms of curative effects, and may be superior to warm-suspended moxibustion with regard to long-term curative effects. Because of low quality of the included RCTs, this conclusion must be bolstered with higher-quality RCTs.

Case Report:Subglottic adenoid cystic carcinoma mistaken for asthma

Adenoid cystic carcinoma rarely occurs within the subglottic larynx. In this study, a case of subglottic adenoid cystic carcinoma was reported. A 54 year-old Chinese woman developed a sudden onset of chest distress and cough worsening after physical exertion, and was diagnosed with, and treated as, bronchial asthma. Regular anti-asthmatic therapy did not improve the symptoms. Until a sudden dyspnea, a cervicothoracic computerized tomography （CT） revealed that her upper airway was obstructed by a laryngeal tumor. The patient was diagnosed with a subglottic adenoid cystic carcinoma and treated with complete surgical excision and adjuvant radiation therapy. Follow-up endoscopy and laryngeal magnetic resonance imaging （MR1） at six months showed no recurrence of the tumor. The diagnosis of subglottic adenoid cystic carcinoma should be considered in patients who are characterized by dyspnea, cough, and stridor, but do not respond to regular anti-asthmatic therapy.