〇 哮喘无法根治但在临床上能够治愈 哮喘是一种反复发作的慢性气道炎症,哮喘患者的气道反应性明显高过正常人.一旦接触到环境中的某一些过敏原(如尘螨、花粉和霉菌等),或发生呼吸道病毒感染,就有可能发作哮喘.如同高血压、糖尿病等慢性疾病一样,是无法根治的.但是不能根治不代表不能治,在临床上,哮喘是一种"可防可治"的疾病,这里的"可治"指的是可以临床治愈,即进行合理的诊断,及时采取科学的治疗,长期规范地应用抑制炎症的药物,同时注意过敏原等环境因素的控制,就能够几年、十几年、几十年不再复发,患者可以像正常人一样工作、学习和运动.

We developed a new method to measure the voxel-based vessel-wall-plus-plaque volume (VWV). In addition to quantifying local thickness change as in the previously introduced vessel-wall-plus-plaque thickness (VWT) metric, voxel-based VWV further considers the circumferential change associated with vascular remodeling. Three-dimensional ultrasound images were acquired at baseline and 1 y afterward. The vessel wall region was divided into small voxels with the voxel-based VWV change (ΔVVol%) computed by taking the percentage volume difference between corresponding voxels in the baseline and follow-up images. A 3-D carotid atlas was developed to allow visualization of the local thickness and circumferential change patterns in the pomegranate versus the placebo groups. A new patient-based biomarker was obtained by computing the mean ΔVVol% over the entire 3-D map for each patient (ΔVVol%¯). ΔVVol%¯ detected a significant difference between patients randomized to pomegranate juice/extract and placebo groups (p = 0.0002). The number of patients required by ΔVVol%¯ to establish statistical significance was approximately a third of that required by the local VWT biomarker. The increased sensitivity afforded by the proposed biomarker improves the cost-effectiveness of clinical studies evaluating new anti-atherosclerotic treatments.

Objective: To investigate the prevalence of asthma among the elderly people in China and to analyze the clinical features, self-management and cognitive level of elderly asthma patients. Methods: According to the multi-stage random cluster sampling methods, a total of 164 215 subjects were visited by a questionnaire in the last epidemiology survey from eight provinces (Beijing, Shanghai, Guangdong, Liaoning, Henan, Shanxi, Jiangsu, Sichuan provinces) and seven regions (north, northeast, southern china, east, south, southwest and northwest) in China from February 2010 to August 2012. 2 034 were diagnosed as asthma. The elderly patients aged ≥65 years were selected from the 2 034 asthma patients. The clinical characteristics, comorbidities, the status of asthma control and self-management and insights of the disease in elderly asthma patients were analyzed. Results: Among the 2 034 asthma patients, 584 (28.7%) were elderly asthmatics aged ≥65 years old and 1 450 (71.3%) were<65 years old. In the elderly asthma group, Early-onset asthma accounted for 439 (75.2%) and 145 (24.8%) were late-onset. The common clinical manifestations of elderly asthma patients were: chest distress 395 (67.6%), wheezing 304 (52.1%), cough 298 (51.0%). Common comorbidities of elderly asthmatics were: chronic obstructive pulmonary disease 144 (24.7%), allergic rhinitis 122(20.9%), gastroesopheal reflux disease (GERD) 114(19.5%), allergic conjunctivitis 86 (14.7%), eczema 82 (14.0%), chronic bronchitis 76 (13.0%). The Asthma Control Test (ACT) scores of elderly asthmatics and non-elderly asthmatics were (18.5±3.2) and (21.7±3.4) respectively. There was a significant difference between the two groups (P=0.042). Of the elderly asthmatics, only 13 (2.2%) patients monitored daily using a peak flow meter. 93 (15.9%) patients aware that asthma was characterized by chronic airway inflammation. 64 (11.0%) asthmatics understood that the treatment goal. Conclusions: The clinical manifestations of elderly asthmatics are atypical, especially paroxysmal wheezing. Asthma in elderly people causes more comorbidities and mortality. The self-management and cognitive level of patients with asthma needs to be improved.

Objective: To investigate the clinical characteristics and risk factors of severe bronchial asthma in Chinese people over 14 years old. Methods: According to the multi-stage random cluster sampling methods, a total of 164 215 subjects were visited by a questionnaire in the epidemiology survey from eight provinces (Beijing, Shanghai, Guangdong, Liaoning, Henan, Shanxi, Jiangsu, Sichuan provinces) located in seven regions (north, northeast, east, central China, south, southwest and northwest) of China from February 2010 to August 2012. A total of 2 034 were diagnosed as asthma. The clinical characteristics and related risk factors of patients with severe asthma in China were analyzed. Results: Among all asthma patients, 560 were newly diagnosed, accounting for 27.5% (560/2 034) and the percentage of previously confirmed patients was 72.5% (1 474/2 034). A total of 145 were eligible for severe asthma, accounting for 9.8% (145/1 474) of previously confirmed asthmatics and 7.1% (145/2 034) of all asthmatics. 83.5% (121/145) severe asthmatics had at least one trigger factor. Correlation analysis showed that the risk factors of severe asthma were: smoking (OR=1.543, 95%CI: 1.250-1.814), obesity (OR=2.186, 95%CI: 1.972-2.354), petting (OR=2.135, 95%CI: 1.904-2.283), combined with allergic rhinitis (OR=3.456, 95%CI: 2.721-4.326), gastroesophageal reflux disease (OR=1.842, 95%CI: 1.682-2.140), bronchiectasis (OR=1.665, 95%CI: 1.347-1.912) or chronic obstructive pulmonary disease (OR=1.312, 95%CI: 1.171-1.694). Conclusions: The most common comorbidities in severe asthmatics in China are allergic rhinitis and gastroesophageal reflux disease. The risk factors of severe asthma include obesity, allergic rhinitis, gastroesophageal reflux disease, chronic obstructive pulmonary disease, bronchiectasis, smoking and petting.

The goal of management for bronchial asthma (referred to as asthma below) is to achieve overall control of the condition, including control of current symptoms and reduction on future risks. Asthma exacerbation as one of critical component of the future risks (1,2), may induce a variety of harms to the host, necessitate additional use of medical resources, impose serious socioeconomic burdens, and represent a significant cause of asthma-related disability and mortality (3). As such, prevention and reduction of the asthma exacerbation are of important relevance in improving the overall control of asthma (2-5).

Objective: To evaluate the changes of asthma control, disease management and perception in recent years in China. Methods: We conducted 2 multi-center, cross-sectional surveys. Outpatient asthmatic patients from 10 cities in mainland China (2007-2008) and 30 central cities from 30 provinces in China (except Tibet)(2015-2016) were recruited respectively. Data of asthma control, disease management and perception from the 2 surveys were compared for 10 cities which took part in both of the 2 surveys. Chi-square test was used for comparison between groups. Results: The asthma control level improved from 28.7%(839/2 928) in 2007-2008 to 39.2%(533/1 361) in 2015-2016(P<0.01). The rate of emergency visits was 18.2%(248/1 362) in 2015-2016, which was lower than that in 2007-2008(33.9%, 1 032/3 044)(P<0.01). The rate of peak flow meter (PFM) usage was 17.9%(244/1 360) in 2015-2016, which was slightly lower than the PFM usage rate in 2007-2008(21.8%, 660/3 030)(P=0.004). 56.0%(763/1 362) of the patients used inhaled corticosteroid (ICS) + formoterol to control asthma when asthma symptoms deteriorated in 2015-2016, which was higher than the result of 2007-2008(31.8%, 803/2 524)(P<0.01). 71.1%(968/1 361) of the patients in 2015-2016 had a right perception on disease nature, while the result in 2007-2008 was 63.3%(1 889/2 986)(P<0.01). 61.6%(839/1 362) of the patients in 2015-2016 had a right perception on medication choice on daily-use first-line medication for chronic asthma, while the result in 2007-2008 was 51.0%(1 500/2 942)(P<0.01). Conclusion: The current level of asthma control and disease perception in China improved significantly in recent years, while the rate of PFM usage showed no significant improvement. Asthma action plan including PFM monitoring and asthma self-management should be further promoted nationwide.

Background: There are limited population based data on the prevalence of asthma in China. The China Asthma and Risk factors Epidemiologic (CARE) survey was designed to understand the prevalence and risk factors for asthma in mainland China. Objectives: The CARE survey aims to demonstrate the prevalence and risk factors of asthma in mainland China among adolescents (age > 14 years) and adults. Methods: The survey was performed between February 2010 and August 2012 in eight provinces/cities of seven areas in mainland China. The inhabitants (age, > 14 years) recruited in this survey were through multi-stage cluster random sampling. Asthma diagnosis was based on medical history and lung function tests. Multivariable logistic regression was used to analyzed the risk factors for asthma. Results: The study included 164 215 subjects (men, 79 692 [48.53%]; women, 84 523 [51.47%]). 2034 (1.24%) were asthmatic patients. Among all asthmatic patients, 521 (25.61%) were newly diagnosed. Univariable regression analysis showed that risk factors for asthma included smoking, first-degree relatives with asthma, allergic rhinitis, chronic bronchitis, COPD, pollinosis, allergic pneumonia, concomitant allergic diseases, BMI and raising pets. Multivariable logistic regression indicated that asthma risk factors included women, age stratification, smoking, first-degree relatives suffering from asthma or pollinosis, combined with allergic rhinitis, eczema or GERD. Conclusions: We speculated that the prevalence of asthma is increasing in mainland China among individuals aged > 14 years in the past 10 years. A number of risk factors were identified. The risk factors of asthma would be further elucidated in our future work. Clinical implications: Our CARE study highlights that asthma epidemic in mainland China should be paid more attention.

Objective: For the past decade, China has been developing a lot in healthcare. The aim of our study was to evaluate the changes of asthma control and management, patients’ perception for the past decade in China. Methods: During the years 2007-2008 or 2015-2016, two multi-center, cross-sectional studies about asthma control and management through questionnaire in outpatient clinics from 10 or 30 cities were conducted in mainland China. The data in 10 cities, which were included in both studies, were compared. Results: Over the past decade, the level of asthma control was improved from 28.7% to 39.2%. The rate of emergency visits was decreased to 18.2% from the previous 33.9%. The use of peak flow meter (PFM) was 17.9% in the year 2015-2016, similar as 21.8% in the year 2007-2008. For the maintenance therapy, the combination of inhaled corticosteroid + long acting β2 agonist was the most common treatment in both studies. In the year 2015-2016, the percentage of patients using the combination therapy was 56.0%, which was higher than 31.8% in the year 2007-2008. As for understanding the essence of asthma as chronic airway inflammation, 71.1% patients in the year of 2015-2016 hold the right perception, while it was 63.3% in the year 2007-2008. In the year 2015-2016, 61.6% patients chose first-line medication, recommended by GINA, for daily use, which was higher than 51.0% in previous study. Conclusion: The asthma control and patients’ perception on asthma were improved significantly in recent years in China. Unfortunately, the use of PFM remained in low level. Asthma action plan including PFM monitoring and asthma self-management should be further advocated nationwide.

Bronchial asthma (referred to as “asthma” hereinafter in this consensus document) is a chronic inflammatory airway disease with well-accepted heterogeneity and complex pathophysiological processes (1). Severe asthma is recognized as a poorly controlled condition that seriously affects quality of life, accounts for massive use of medical resources, and imposes huge socioeconomic burdens, representing a primary cause of asthma-related disability and death in the patients (2-5). In this regard, improving the diagnosis and treatment of severe asthma should be of paramount importance towards better outcomes in overall control and prognosis, as well as lower medical costs (5).

Objective: To study the relationship between bronchial asthma and smoking status in Chinese people. Methods: Asthma epidemiological survey and stratified-cluster-random method survey were performed in residents over 14 years in 8 provinces (cities) of China from February 2010 to August 2012. Asthma was diagnosed based upon case history, clinical signs and lung function test. Smoking status was investigated by questionnaire. Results: Sampling population was 180 099 and 164 215 were valid. A total of 2 034 subjects were diagnosed as asthma including 79 692 men and 84 523 women. The overall prevalence rate of asthma was 1.24% (2 034/164 215). Smokers were 23.8% (39 137/164 215) in the whole population. Smokers were 34.5% (702/2 034) in asthmatic patients, compared with 23.7% (38 435/162 181) in no-asthmatic population. The incidence of asthma was 1.79% and 1.06% in smokers and non-smokers respectively (P<0.001), suggesting that OR of smoking was 1.70 (95% CI 1.55-1.86, P<0.001). According to asthma control test (ACT) score, the level of asthma control in non smoking group was higher than that in smoking group(43.2% vs 35.3%). The times of hospitalization due to acute exacerbations(0.51 vs 0.41 events/person/year), total hospitalization rate(27.35% vs 20.12%), annual emergency room visits (0.80 vs 0.60 events/person/year) and emergency room visit rate (31.77% vs 24.47%) were all much higher in smoking asthmatic patients than those in non smoking asthmatic patients, indicating that the level of asthma control in smoking patients was significantly worse than in non smoking patients. Conclusions: The smoking rate in Chinese people over 14 years is still high. The prevalence rate of asthma in smokers is significantly higher than that of non-smokers. The level of asthma control in smokers is significantly worse than that in non smokers.

Objective: To analyze the prevalence of severe asthmain China. Methods: The epidemiological data was collected from 2 034 asthmatics who were diagnosed in the last epidemiological survey from 2009 to 2010 in 8 provinces. Results: According to the questionnaire survey, among the 2 034 patients, the previously diagnosed patients accounted for 72.47% (1 474/2 034) and the percentage of newly-diagnosed patients was 27.53% (560/2 034). In those 1 474 previously diagnosed asthmatics, 122 (8.28%) were classified into severe asthma, while 6.00% (122/2 034) of all asthmatics and 0.07% (122/164 215) of total respondents presented as severe cases. Statistically, there was no difference in the prevalence of severe patients between men and women. The morbidity rate of severe asthma was the lowest in the 21-30 year old group and the highest in 61-70 year old group (0.85% and 8.31% respectively). The difference among ages was statistically significant (χ2=18.791, P=0.005). In addition, the prevalence rates of severe asthma were also significantly diverged among patients with different education background(χ2=24.639, P<0.000 1). A negative relation was found between education level and the proportion of severe cases. Moreover, the morbidity of severe asthma in smoking patients and non-smoking patients were significantly different as well (χ2=7.447, P<0.05). Compared with asthma patients who do not smoke, smokers were more likely to suffer severe asthma (OR=1.663, 95% CI 1.150-2.404). Conclusions: The prevalence rate of severe asthma in China is similar to that in other countries.Elderly patients have higher risk of severe asthma. Smoking is considered as a risk factor for severe asthma.

Bronchial asthma(asthma) is a heterogeneous disease characterized by chronic airway inflammation.Asthma is usually associated with airway hyperresponsiveness and airway inflammation,but these are not necessary to make the diagnosis.Clinical management of asthma need the individual treatment,therefore this article reviews the advances of clinical management of asthma in recent years.

Objective: Analyze the prevalence rate and clinicalcharacteristics of severe asthma in China. Methods: Through the analysis of relevant data of China Asthma and Risk factors Epidemiologic investigation (CARE study).Using multi-stage random cluster sampling method, epidemiological survey was performed on asthma prevalence in Chinese residents over 14 years old in 8 provinces(cities)the. Detailed epidemiological data was collected via face-to-face home visit interview among 2034 asthmatics whowere diagnosed in the last epidemiology survey from 2009 to 2010. Asthma was diagnosed based on case history, clinical signs and lung function test. The SPSS12.0 software was applied for statistical analysis and the status of asthma control was investigated. Results: According to the questionnaire survey, The “severe asthma” prevalence rate was 5.99% (122/2034) without differences in both genders. In the 61 ∼ 70 age group and the patients whose education level were below primary school, severe asthma had the highest percentages (8.31%, and > 8% respectively). Compared with asthma patients who do not smoke, smokers were more likely to suffer severe asthma (OR = 1.663, 95% CI [1.150 ∼ 2.404]). Conclusions: The prevalence of severe asthma is similar in China and other regions.Severe asthma in elderly patients was more prevalent. Smoking may be a risk factor for severe asthma.

Objective To determine pathogens and drug resistance of lower respiratory tract infection in patientsre -ceiving mechanical ventilation in ICU and to provide the reference for clinical prevention and treatment .Methods The positive phlegm samples of ICU patients from Jun 2012 to Jun 2013 were analyzed by using retr ospectiv eanalysis .Both bacterial identification and drug susceptibility test .Results A total of 310 pathogens were detected from 280 sputum specimens,including 225 strains(72.6%)of Gram-negative bacilli,58 strains(18.6%)of Gram-positive bacilli and 27 strains(8.8%)of fungi.The most common Gram-negative bacilli were P.Aeruginosa, Acinetobacter baumannii , Es-cherichiacoli , and Klebsiella pneumonia .The most common Gram -positive bacilli were Stap hylococcus aureus and Staphylococcus .Fungi27 strains ( 8.8%) , Moniliaalbican mainly .The drug susceptibility test showed that pathogens were of severe antibiotic resistance to beta -lactams,aminoglycosides and macrolides , Acinetobacter baumannii was se-rious antibiotic resistance to carbopenems , and none of Stap hylococcus aureus was detected for antibiotic resistance to vancomycin.Conclusi ons With antibiotic resistance of pathogens in lower airways infection was performing more and more seriously ,especially with the increasing of CRAB and mixed infection of Gram -positive bacilli Pulmonary infections in ICU are mainly caused by Gram -negative and Gram-negat ive bacillus.So,satisfactoryefficacy can be achieved by drug sensitivity tests at regular intervals and resistance t rend analysis for guiding the use of antibiotics .

OBJECTIVE:Through the analysis of relevant data of China Asthma and Risk factors Epidemiologic investigation (CARE study), we understand the status quo of management and insights of asthma patients in our country.METHODS:Using multi-stage random cluster sampling method, epidemiological survey was performed on the prevalence rate in 8 provinces (cities) of China residents who aged over 14 years from 2009 to 2010. Detailed epidemiological data was collected via face-to-face home visit interview among 2 034 asthmatics who were diagnosed in the last epidemiology survey. Asthma was diagnosed based upon case history, clinical signs and lung function test. The SPSS12.0 software was conducted for statistical analysis and the status of asthma control was investigated.RESULTS:This survey has shown that 22.71% (462/2 034) asthmatics had ever taken a lung functional test in the past year. A total of 294 (14.45%) people had peak flow meters but only 1.62% (33/2 034) regularly used it daily. There were 22.42% (456/2 034) asthmatics aware that bronchial asthma is characterized by chronic airway inflammation. 14.85% (302/2 034) asthmatics understood that the treatment goal of this disease is long-term good control or complete control. This survey has found that 59.64% (1 213/2 034) patients complained that asthma has affected their work, life and entertainment, including 8.90% (181/2 034) asthmatics dependent on instruments in daily life and 4.57% attempting to suicide. This suggested that allergic asthma has seriously decreased the quality of life.CONCLUSION:Therefore it is necessary to educate the asthmatics, guide the patients to the long-term management and standardized therapy and raise the level of disease understanding, thus reducing the burden of disease to society. Gaining better insight of patient's attitude about self-care is critical to the improvement of asthma management.

支气管哮喘（哮喘）最重要的病理学改变是气道的慢性炎症,而气道炎症水平与气道高反应性密切相关,是出现临床症状的根本原因[1]。因此,气道炎症的评估,特别是无创气道炎症评估方法的发展和临床应用,对于更加深入了解哮喘的病理生理改变和特征,指导哮喘的管理,更好地达到哮喘的总体控制目标有着重要的意义[2]。中国医师协会呼吸医师分会和中国哮喘联盟组

目的:探讨Toll样受体(Toll-like receptor,TLR)2亚家族基因单核苷酸多态性(single nucleotide polymorphisms,SNP)与中国东南方成人哮喘以及其临床表型之间的关系.方法:共招募哮喘患者318例,正常对照352例,TLR2亚家族中共8个SNP使用SNPstream方法进行了基因分型.对各SNP和单倍型与哮喘及其表型进行了分析.结果:运用Logistic回归分析后,发现rs7656411/TLR2突变基因型TT与野生型rs7656411 GG比较能明显降低37％哮喘的发生(校正OR=0.63,95％CI:0.41～0.98,P=0.41),rs7656411 TT+GT与哮喘无明显关系(校正OR=0.77,95％ CI:0.54～1.09,P＞0.05).携有rs2381289/TLR6 T等位基因的哮喘患者患过敏性鼻炎的危险度为不携带此等位基因哮喘患者的1.79倍(95％CI:1.10～2.91,P=0.025),然而携有rs11466651/TLR10 A等位基因的哮喘患者患过敏性鼻炎的危险度较不携带此等位基因的哮喘患者下降了51％(95％CI:0.26～0.95,P=0.046).结论:TrLR2亚家族基因的突变可能在哮喘易感性中起着重要作用.

Objective: To evaluate the efficacy of FEV6as surrogate for FVC in the diagnosis of COPD, and to determine the fixed cut-off point of FEV1/FEV6 which can be used as an alternative for FEV1/FVCMethods Spirometry measurements were performed in 128 COPD patients, FEV1,FEV6,FVc, FEV1% pred, FVC% pred FEV1/FVC,and FEV1/FEV6 were measured and analyzed. FEV1/FVC < 70% was used as the "gold stadard".Severity of obstruction was based on FEV1% pred. Results: There were 51% participants with FEV1/FVC>=70%,49% with FEV1/FVC <70%.Linear correlation was revealed between FEV1/FVC and FEV1/FEV6 with the value close to 1.From ROC curve analysis, the FEV1/FVE6<71.14% was the best cut-off point corresponding to FEV1/FVC <70%. Conclusion: These reseach results suggest that FEV1/FEV6 is a valid alternative to FEV1/FVC for spirometric diagnosis of airway obstruction.