American Journal of Respiratory Medicine

MJ Abramson

MJ Bailey

AB Forbes

EH Walters

How well do doctors know their patients with severe asthma

医生对重度哮喘患者的了解程度如何

Measurement of health-related quality of life (HR-QOL) may show benefits of asthma treatments not revealed by objective monitoring and can complement clinical and physiological assessments of treatment outcome. HR-QOL was measured in four countries in a multicenter, double-blind, randomized comparison of salmeterol/fluticasone propionate combination and budesonide in patients aged > or =12 years with moderate-to-severe asthma uncontrolled by inhaled corticosteroids.

Elizabeth F. Juniper

Christine Jenkins

Martin J. Price

Mark H. James

Am J Respir Med

Impact of Inhaled Salmeterol/Fluticasone Propionate Combination Product versus Budesonide on the Health-Related Quality of Life of Patients with Asthma

吸入沙美特罗/氟替卡松联合制剂与布地奈德对哮喘患者健康相关生活质量影响的比较

Leukotriene modifiers have been shown to be efficacious in the treatment of asthma. Because of this success, and the fact that leukotrienes can be recovered not only from bronchoalveolar lavage fluid but also nasal lavage fluid, some researchers have suggested that these medications may also be useful for treating allergic rhinitis. Because the upper and lower airways are linked physically, there has been an assumption that therapy for upper and lower airway disease should be similar. This critical appraisal examines available data both supporting and refuting the emerging role of leukotriene modifiers in the treatment of allergic rhinitis. Although many studies have shown an improvement in nasal symptoms when comparing a leukotriene modifier with placebo, few studies have conclusively shown that a leukotriene modifier is any more effective in treating allergic rhinitis than an antihistamine. Results from several reported studies suggest that the addition of a leukotriene antagonist to an antihistamine is no more efficacious than antihistamine alone. However, many of these studies were small and/or primarily designed to examine the asthmatic response, with nasal symptoms being a lesser endpoint. To better understand how, where, and when leukotriene modifiers should be used in the armamentarium of therapies for allergic rhinitis, larger clinical investigations designed specifically to study allergic rhinitis need to be undertaken. We conclude that currently, the data do not support widespread use of a leukotriene modifier with or without an antihistamine in place of an intranasal corticosteroid with or without an antihistamine in the treatment of allergic rhinitis.

Mitchell H. Grayson

Phillip E. Korenblat

The Emerging Role of Leukotriene Modifiers in Allergic Rhinitis

白三烯修饰剂在过敏性鼻炎中的新兴作用

Despite attempts to limit their use, systemic antibiotics are extensively prescribed for respiratory infections in France. This survey analyzed data from the Thales database, which contains information from 1010 representative French general practitioners (GPs). The objective was to assess French GP prescribing patterns in upper respiratory tract infections (URTIs) including the rate of prescription of systemic antibiotics and anti-inflammatory drugs in the presence or absence of prescribing fusafungine (Locabiotal) an antibiotic with anti-inflammatory activity indicated for local use in URTIs. Drug costs to the French National Sickness Fund were also assessed.

Francis Fagnani

Michèle German-Fattal

Antibiotic Prescribing Patterns of French GPs for Upper Respiratory Tract Infections

法国全科医生对上呼吸道感染的抗生素处方模式

Among all nonmetastatic non-small-cell lung cancer (NSCLC) patients, the best survival rates are observed in patients who undergo surgery. Nevertheless, 5-year survival rates vary between 20% and 60% depending on the stage of the disease. Several combined modality treatments have been investigated to improve outcome in localized NSCLC. These include local treatment, systemic before local treatment, concomitant systemic and local treatments, and systemic after local treatment. Preoperative irradiation was shown to be of no benefit on local recurrence rates or overall survival. Even doses of radiation >/=40 grays (Gy) were associated with lower survival rates. Postoperative irradiation did not influence survival in stage III disease and seemed to be deleterious in stages I and II disease. Modern radiotherapy techniques might be of interest in this setting but have been insufficiently tested. The early phase III studies of preoperative chemotherapy versus primary surgery in stage III NSCLC showed a tremendous difference in favor of chemotherapy. A larger study did not confirm these results but suggested that preoperative chemotherapy might have a greater effect in stages I and II of the disease. In locally advanced disease, chemotherapy followed by radiotherapy was shown to increase survival when compared with radiotherapy alone. Studies comparing concurrent chemoradiation with radiotherapy only were in favor of the concomitant schedule, which improved local control. Promising results have been reported with chemoradiation followed by surgery in stage IIIa and even stage IIIb disease. Randomized studies of postoperative chemotherapy demonstrated a 5% improvement in 5-year survival over adjuvant-free treatment. Postoperative chemoradiation showed no advantage over postoperative radiotherapy. Several trials that are ongoing or whose accrual was recently completed should further define the role of perioperative chemotherapy in resectable NSCLC and of trimodality treatments in advanced disease. Targeted agents are being developed in the postoperative setting. New schedules of chemoradiation with higher therapeutic indexes are also being investigated in nonresectable stage III NSCLC.

Virginie Westeel

Alain Depierre

Combined Modality Treatment of Non-Small-Cell Lung Cancer

非小细胞肺癌的联合模式治疗

Pregnancy rhinitis is defined as nasal congestion in the last 6 or more weeks of pregnancy, without other signs of respiratory tract infection and with no known allergic cause, with complete resolution of symptoms within 2 weeks after delivery. Pregnancy rhinitis occurs in approximately one-fifth of pregnancies, can appear at almost any gestational week, and affects the woman and possibly also the fetus. The pathogenesis of pregnancy rhinitis is not clear, but placental growth hormone is suggested to be involved. Smoking and sensitization to house dust mites are probable risk factors. It is often difficult to make a differential diagnosis from sinusitis: nasendoscopy of a decongested nose is the diagnostic method of choice. In some cases ultrasound or x-ray may be necessary. Sinusitis should be treated aggressively with increased doses of beta-lactam antibiotics and antral irrigation. Nasal decongestants give good temporary relief from pregnancy rhinitis, but they tend to be overused, leading to the development of rhinitis medicamentosa. Corticosteroids have not been shown to be effective in pregnancy rhinitis, and their systemic administration should be avoided during pregnancy. Nasal corticosteroids may be administered to pregnant women when indicated for other sorts of rhinitis. Nasal alar dilators and saline washings are safe means to relieve nasal congestion, but the ultimate treatment for pregnancy rhinitis remains to be found.

Eva K. Ellegård

The Etiology and Management of Pregnancy Rhinitis

妊娠鼻炎的病因及管理

COPD is a common disease with increasing prevalence. The chronic course of the disease is characterized by acute exacerbations that cause significant worsening of symptoms. Bacterial infections play a dominant role in approximately half of the episodes of acute exacerbations of COPD. The importance of pseudomonal infection in patients with acute exacerbations of COPD stems from its relatively high prevalence in specific subgroups of these patients, and particularly its unique therapeutic ramifications. The colonization rate of Pseudomonas aeruginosa in patients with COPD in a stable condition is low. A review of a large number of clinical series of unselected outpatients with acute exacerbations of COPD revealed that P. aeruginosa was isolated from the patients’ sputum at an average rate of 4%. This rate increased significantly in COPD patients with advanced airflow obstruction, in whom the rate of sputum isolates of P. aeruginosa reached 8–13% of all episodes of acute exacerbations of COPD. However, the great majority of bacteria isolated in these patients were not P. aeruginosa, but the three classic bacteria Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. The subgroup of patients, with acute exacerbations of COPD, with the highest rate of P. aeruginosa infection, which approaches 18% of the episodes, is mechanically ventilated patients. However, even in this subgroup the great majority of bacteria isolated are the above-mentioned three classic pathogens. In light of these epidemiologic data and other important considerations, and in order to achieve optimal antibacterial coverage for the common infectious etiologies, empiric antibacterial therapy should be instituted as follows. Patients with acute exacerbations of COPD with advanced airflow obstruction (FEV1 <50% of predicted under stable conditions) should receive once daily oral therapy with one of the newer fluoroquinolones, i.e. levofloxacin, moxifloxacin, gatifloxacin, or gemifloxacin for 5–10 days. Patients with severe acute exacerbations of COPD who are receiving mechanical ventilation should receive amikacin in addition to one of the intravenous preparations of the newer fluoroquinolones or monotherapy with cefepime, a carbapenem or piperacillin/tazobactam. In both subgroups it is recommended that sputum cultures be performed before initiation of therapy so that the results can guide further therapy.

David Lieberman

Devora Lieberman

Pseudomonal Infections in Patients with COPD

慢性阻塞性肺疾病患者的假单胞菌感染

出版信息	出版商: Adis International Ltd，出版周期: ，期刊类型: journal，开源期刊: 否
基本数据	创刊年份: 2002，原创研究文献占比: ，自引率:， Gold OA占比:

American Journal of Respiratory Medicine

期刊引文格式

有 1 位以上作者的期刊

有 2 位作者的期刊

有 3 位作者的期刊

有 5 位以上作者的期刊

书籍引用格式

学位论文引用格式

网页引用格式

专利引用格式

手工熬夜修改参考文献？研飞自动匹配期刊，一键轻松成稿，支持 Word/WPS

投稿经验分享

How well do doctors know their patients with severe asthma

How well do doctors know their patients with severe asthma

Impact of Inhaled Salmeterol/Fluticasone Propionate Combination Product versus Budesonide on the Health-Related Quality of Life of Patients with Asthma

How well do doctors know their patients with severe asthma

How well do doctors know their patients with severe asthma

The Emerging Role of Leukotriene Modifiers in Allergic Rhinitis

Antibiotic Prescribing Patterns of French GPs for Upper Respiratory Tract Infections

Combined Modality Treatment of Non-Small-Cell Lung Cancer

The Etiology and Management of Pregnancy Rhinitis

Pseudomonal Infections in Patients with COPD