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Drug utilization study in patients with bronchial asthma of a tertiary care hospital in Western Maharashtra 马哈拉施特拉邦西部一家三级医院支气管哮喘患者的药物利用研究
Pub Date : 2019-07-01 DOI: 10.4103/ijaai.ijaai_17_19
R. Shah, S. Burute, S. Ramanand, M. Murthy, N. Shah, Arvind V. Kumbhar
BACKGROUND: Drug utilization studies (DUS) are necessary for knowing the extent of drug use and identify variability in drug use among different regions. Bronchial asthma is known to be one of the major causes of morbidity and mortality in India. There is paucity of Indian data which evaluate the pattern of drug utilization in bronchial asthma over its entire spectrum and varying severity. Hence, the present study was designed to assess the drug utilization pattern in all bronchial asthma patients at a tertiary care hospital to understand the current prescription trends and to determine areas in need of further research. MATERIALS AND METHODS: A prospective, observational study for a period of 1 year from February 2014 to January 2015 was conducted at the outpatient and inpatient departments of medicine and pediatrics, government teaching tertiary care hospital, Maharashtra. The WHO's prescribing indicators were used for evaluating DUS. Assessment of the overall pattern of drug use and antiasthmatic drugs was done. Data were analyzed using descriptive studies. RESULTS: Data of 250 asthma patients showed a male preponderance (males vs. females 52.8% vs. 47.2%). The average number of drugs per encounter was 6.10. Only 33.9% of the drugs were prescribed by generic name, and a higher percentage (64.8%) of antibiotics were prescribed. Nearly 69.44% of the prescribed drugs were from essential drug list. The overall pattern of drug use showed that β2 agonists (100% and 97.33%) and corticosteroids (92.57% and 94.66%) were the most common classes of antiasthmatic drugs prescribed in medicine and pediatric departments, respectively. One important finding was that inhaled salbutamol and inhaled corticosteroid were prescribed less commonly. CONCLUSIONS: The present study identifies the need for prescription by generic name and improvement in prescribing practices with current recommendations or guidelines for the management of bronchial asthma. This will help ensure rational use of drugs.
背景:药物利用研究(DUS)是了解药物使用程度和确定不同地区药物使用差异的必要条件。支气管哮喘是印度发病率和死亡率的主要原因之一。印度缺乏评估支气管哮喘整个频谱和不同严重程度的药物使用模式的数据。因此,本研究旨在评估三级医院所有支气管哮喘患者的药物使用模式,以了解当前的处方趋势,并确定需要进一步研究的领域。材料与方法:2014年2月至2015年1月在马哈拉施特拉邦政府三级教学医院内科和儿科门诊和住院部进行为期1年的前瞻性观察性研究。世卫组织的处方指标用于评估DUS。对用药及平喘药物的总体情况进行评价。数据采用描述性研究进行分析。结果:250例哮喘患者的数据显示男性优势(男性比女性52.8%比47.2%)。每次接触的平均药物数量为6.10。仅33.9%的药品以通用名开具处方,抗生素的使用比例更高(64.8%)。近69.44%的处方药来自基本药物清单。总体用药情况显示,β2激动剂(100%和97.33%)和皮质类固醇(92.57%和94.66%)分别是内科和儿科最常用的平喘药。一个重要的发现是,吸入沙丁胺醇和吸入皮质类固醇的处方较少。结论:本研究确定了按通用名称开具处方的必要性,并根据目前支气管哮喘治疗的建议或指南改进处方实践。这将有助于确保合理用药。
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引用次数: 2
Characteristics of bronchial asthma with persistent airflow limitation 持续气流受限支气管哮喘的特点
Pub Date : 2019-01-01 DOI: 10.4103/ijaai.ijaai_35_18
D. Rai, Shiv Kumar, A. Ranjan, R. Kirti
BACKGROUND: Asthma is a chronic inflammatory disorder of airway characterized by variable symptoms and variable airflow limitation. There are many patients developed persistent airflow limitation in due course of disease due to many factors. The present study was conducted to characterize this phenotype and to identify the factors which are implicated in causing persistent airflow limitation. MATERIALS AND METHODS: We recruited consecutive 164 patients aged <40 years (to exclude chronic obstructive pulmonary disease [COPD]), diagnosed, and treated as bronchial asthma in our asthma clinic for at least 6 months. We took all clinical, lung function detail and compared between asthma with or without persistent airflow limitation. The patients were assigned to the group with persistent airflow obstruction if they presented postbronchodilator forced expiratory volume in 1 s (FEV1) or FEV1/forced vital capacity values <70% predicted. RESULTS: A total of 114 patients included in the study and 42 (36.84%) patients had persistent airflow limitation. The patients with persistent airflow limitation have a higher age and more proportion of patients were male. History of allergic rhinitis is an important risk factor found associated with asthma with persistent airflow limitation (P≤ 0.001). 26.19% of patients with persistent airflow limitation had a history of symptom since childhood and generally having a longer disease duration compared to patient without airflow limitation (P < nonsignificant). Reversibility criteria (>12% and >200 ml increase in FEV1) was fulfilled by only 26.7% of the study patients. The factors such as onset of disease after 18 years, history of atopy, serum IgE level, family history of asthma, and biomass fuel exposure did not differ between groups with or without airflow limitation. CONCLUSIONS: Bronchial asthma is more having a COPD such as spirometry features if it has been started since childhood, longer disease duration, and history of allergic rhinitis. Reversibility in spirometry, which is specific for asthma diagnosis, is found only in one-fourth of the patients.
背景:哮喘是一种以不同症状和不同气流限制为特征的气道慢性炎症性疾病。由于多种因素,许多患者在疾病的适当时期出现了持续的气流限制。本研究的目的是表征这种表型,并确定导致持续气流限制的因素。材料与方法:我们连续招募了164例年龄为12%的患者,只有26.7%的研究患者达到了200 ml的FEV1增加。18年后发病、特应性史、血清IgE水平、哮喘家族史和生物质燃料暴露等因素在有或没有气流限制的组之间没有差异。结论:如果支气管哮喘自儿童期开始、病程较长且有变应性鼻炎史,则支气管哮喘更具有COPD(如肺活量测定)特征。仅在四分之一的患者中发现了用于哮喘诊断的肺活量测定的可逆性。
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引用次数: 0
An Indian perspective on dust mites 印度人对尘螨的看法
Pub Date : 2019-01-01 DOI: 10.4103/ijaai.ijaai_9_19
S. Gaur
Dust mites are the most important group of indoor allergens. The dust mites have been classified as house dust mites and storage mites, however, with recent knowledge the different dust mite species are now labelled as “domestic mites.” The dust mites have been isolated at numerous Indian locations and their sensitization in Indian population has also been documented. In view of high sensitization in India, it is important to recognize the role of dust mites and their allergens in the precipitation of allergic diseases including allergic rhinitis and asthma. Allergies to dust mites can be confirmed by a classical clinical history of perennial, early morning and indoor symptoms substantiated by a positive skin prick test to these allergens. Further management of allergies to mites is possible using appropriate allergen avoidance measures and allergen immunotherapy. Multifaceted avoidance measures can be used, but, allergen avoidance by the means of an allergen impermeable bed encasings has the best evidence and is recommended in different guidelines. Allergen immunotherapy, the disease-modifying modality, has been proven to efficacious for house dust mite allergies.
尘螨是室内最重要的过敏原。尘螨被分为室内尘螨和仓库尘螨,然而,随着最近的知识,不同的尘螨物种现在被标记为“家螨”。尘螨已被隔离在许多印度地点和他们的敏化在印度人口也有记录。鉴于印度的高致敏性,重要的是要认识到尘螨及其过敏原在过敏性疾病(包括过敏性鼻炎和哮喘)的发生中的作用。尘螨过敏可通过对这些过敏原的皮肤点刺试验阳性证实的多年性、清晨和室内症状的经典临床病史来证实。使用适当的过敏原避免措施和过敏原免疫治疗,对螨虫过敏的进一步管理是可能的。可以使用多方面的避免措施,但是,通过不渗透过敏原的床壳来避免过敏原有最好的证据,并在不同的指南中得到推荐。过敏原免疫治疗是一种改善疾病的方法,已被证明对屋尘螨过敏有效。
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引用次数: 2
Environmental triggers in allergic diseases: An overview 过敏性疾病的环境诱因:综述
Pub Date : 2019-01-01 DOI: 10.4103/ijaai.ijaai_5_19
A. Singh
Allergy and asthma are increasing all over the world including India. The most effective method of management of allergic diseases is prevention and avoidance where ever possible natural history of allergy is influenced by many triggering Biological and non biological agents. Identification of these triggers such as pollen, moulds, mites and insect debris etc., are major factors for secondary prevention of environmental allergens. It is suggested in this brief review that educational programs should focus on avoidance of these triggers for effective management in addition to other forms of therapy.
过敏和哮喘在包括印度在内的世界各地都在增加。管理过敏性疾病最有效的方法是预防和避免过敏的自然历史受到许多触发生物和非生物因素的影响。识别花粉、霉菌、螨虫和昆虫碎片等诱发因素是二级预防环境过敏原的主要因素。在这篇简短的综述中建议,除了其他形式的治疗外,教育计划应侧重于避免这些触发因素以进行有效的管理。
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引用次数: 0
Homologous allergens: A regulatory and clinical perspective 同源过敏原:调控和临床观点
Pub Date : 2019-01-01 DOI: 10.4103/ijaai.ijaai_13_19
S. Gaur
The last decade has ushered new data on the allergenic molecules. Allergens from identical protein families are now known to be present in different allergen sources and are labeled as homologous allergens. An important fact for such allergens is that they may be present among different sources, and their presence is not conditional to taxonomical relationship. These allergenic molecules express sequence identity and clinical cross‐reactivity. This principle of homologous allergens was brought forward by Lorenz et al.[1] They also suggested that “classification of allergen sources in one homologous group on the basis of homology and cross‐reactivity of allergens is more specific and satisfactory than mere taxonomic relationship.”[1]
在过去的十年里,有了关于致敏分子的新数据。来自相同蛋白家族的过敏原现在已知存在于不同的过敏原来源中,并被标记为同源过敏原。这类过敏原的一个重要事实是,它们可能存在于不同的来源中,并且它们的存在不以分类关系为条件。这些致敏分子表达序列同一性和临床交叉反应性。同源过敏原原理是由Lorenz等人提出的[1],他们还认为“根据过敏原的同源性和交叉反应性对同一个同源类群的过敏原源进行分类比单纯的分类关系更具体、更令人满意”[1]。
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引用次数: 0
Angina bullosa hemorrhagica: A rare case report in known asthmatic on inhaled corticosteroids 大疱性出血性心绞痛:一个罕见的病例报告在已知的哮喘吸入皮质类固醇
Pub Date : 2019-01-01 DOI: 10.4103/ijaai.ijaai_24_18
Sonal Arsude, B. Supekar, Ankita Jire
Angina bullosa hemorrhagica (ABH) is characterized by development of acute onset of painless solitary or multiple blood-filled vesicles or bullae in oral mucosa which are not attributed to blood dyscrasias, vesiculobullous disorder, and systemic diseases. These lesions rupture spontaneously to form ragged, often painless, superficial erosions that heal spontaneously within 1 week without scarring. Trauma appears to be the most common identifiable precipitating factor. We report a case of ABH to emphasize the importance of recognition of this relatively rare benign condition and to differentiate it from other dermatological and systemic causes of oral blisters.
大疱性出血性心绞痛(ABH)的特点是急性发作时口腔黏膜出现无痛的单发或多个充满血液的小泡或大泡,而不是由于血液紊乱、小泡紊乱和全身性疾病引起的。这些病变会自发破裂,形成粗糙的、通常无痛的、表面的糜烂,在1周内自发愈合,不会留下疤痕。创伤似乎是最常见的可识别的诱发因素。我们报告一例ABH,以强调认识这种相对罕见的良性状况的重要性,并将其与其他皮肤病和全身原因的口腔水疱区分开来。
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引用次数: 1
A clinico-epidemiological study on urticaria cases in various tertiary care hospitals affiliated to a medical college in Mangalore, India 印度芒格洛尔一所医学院附属三级医院荨麻疹病例的临床流行病学研究
Pub Date : 2019-01-01 DOI: 10.4103/ijaai.ijaai_36_18
N. Joseph, A. Suman, Siddhika Dangayach, K. Sahni, P. Chaturvedi, N. Ramachandran
BACKGROUND: Urticaria affects one in every five persons in the population. OBJECTIVES: This study was done to study the risk factors, clinical presentation, and management practices among patients with urticaria. METHODS: Information from the medical case records of confirmed cases of urticaria at a government and private tertiary care hospital over the recent 4 years were recorded in a semi-structured pro forma. RESULTS: Mean age of 115 patients was 31.2 ± 20.7 years. Majority of patients (69, 60%) had acute urticaria. The most common risk factors of urticaria in this study were allergy to food substances (27, 23.5%) and allergy to medications (18, 15.6%), followed by insect bites (16, 13.9%). Family history of urticaria was present in 8 (7%) patients. The most common symptom in urticaria was pruritus (68, 59.1%) and the most common sign was hives (40, 34.8%). Lesions were present all over the body in 52 (45.2%) and were bilateral in distribution in 59 (51.3%) patients. Sixty-eight (59.1%) and 69 (60%) urticaria patients were prescribed nonsedating and second-generation antihistamine (sgAH) drugs, respectively. Among chronic urticaria (CU) cases, 35 (76.1%) each received nonsedating and sgAH. Systemic steroids and topical steroid creams were prescribed in 21 (18.3%) and 7 (6.1%) urticaria patients, respectively. Mean duration of application of the topical steroid creams was 10 ± 4.8 days. Leukotriene antagonists were used in the management of greater proportion of patients (54.5%) with dermographism in comparison to 16.1% without dermographism (P < 0.001). CONCLUSION: The study reported few important risk factors and certain common clinical presentation in urticaria. Second-generation nonsedating type of antihistamine drugs was the most preferred drug for the management of urticaria.
背景:人群中每五个人中就有一人患有荨麻疹。目的:本研究旨在研究荨麻疹患者的危险因素、临床表现和治疗方法。方法:对某公立三级医院和私立三级医院近4年的荨麻疹确诊病例病历资料进行半结构化记录。结果:115例患者平均年龄31.2±20.7岁。大多数患者(69,60 %)有急性荨麻疹。本研究中最常见的荨麻疹危险因素为食物过敏(27,23.5%)和药物过敏(18,15.6%),其次是昆虫叮咬(16,13.9%)。8例(7%)患者有荨麻疹家族史。荨麻疹最常见的症状是瘙痒(68例,59.1%),最常见的体征是荨麻疹(40例,34.8%)。52例(45.2%)患者出现全身病变,59例(51.3%)患者出现双侧病变。68例(59.1%)和69例(60%)荨麻疹患者分别使用非镇静和第二代抗组胺(sgAH)药物。在慢性荨麻疹(CU)病例中,35例(76.1%)分别接受非镇静和sgAH治疗。21例荨麻疹患者(18.3%)和7例荨麻疹患者(6.1%)分别使用全身类固醇和局部类固醇药膏。外用类固醇药膏的平均使用时间为10±4.8天。使用白三烯拮抗剂治疗有人口统计学异常的患者比例(54.5%)高于无人口统计学异常的患者比例(16.1%)(P < 0.001)。结论:本研究报告了一些重要的危险因素和一些常见的荨麻疹临床表现。第二代非镇静型抗组胺药是治疗荨麻疹的首选药物。
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引用次数: 2
Hand Book on Adverse Drug Reactions in T B Treatment 结核治疗药物不良反应手册
Pub Date : 2019-01-01 DOI: 10.4103/IJAAI.IJAAI_7_19
SN Gaur
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引用次数: 0
Bronchial asthma: Prevalence and risk factors among children in urban population from Raipur, Chhattisgarh 支气管哮喘:恰蒂斯加尔邦赖布尔城市人口中儿童的患病率和危险因素
Pub Date : 2019-01-01 DOI: 10.4103/ijaai.ijaai_26_18
V. Kumari, T. Jagzape
OBJECTIVES: Bronchial asthma is an important chronic disease in children leading to school absenteeism, hospitalization, economic and psychological stress in the family. Worldwide, the prevalence of asthma is on rise. There is a paucity of information on the prevalence of bronchial asthma in childhood in Central India. Hence, this community-based study was conducted with an objective to estimate the prevalence of asthma and identify associated risk factors in children between 6 and 14 years of age. MATERIALS AND METHODS: This cross-sectional study using modified International Study of Asthma and Allergies in Childhood questionnaire was conducted in the urban area of Raipur, Chhattisgarh, India. The calculated study sample of 175 children in the age group of 6–14 years was recruited using multistage random sampling. RESULTS: Of 175 (88 males and 87 females), 13.14% (23) of the participants had wheezing at any time in the past and 5.14% had wheezing in the past 1 year (asthma prevalence). The prevalence was slightly more (5.9%) in 6–9 years. Boys had more prevalence (5.6%) than girls (4.6%). However, more girls were affected (5.4% vs. 3.7%) in the age group of 10–14 years. Major risk factors with statistically significant “P” values were allergic rhinitis (66.6%) (Relative Risk (RR) = 6.9), family history of bronchial asthma (66%) (RR = 4.6), maternal asthma (33.3%) (RR = 6.9), and upper socioeconomic class (55.5%) (RR = 2.9%). Important triggers were inhalants, cold exposure, exercise, irritants, and infections. CONCLUSION: The prevalence of asthma in children was 5.14%. The significant risk factors were allergic rhinitis and family history of asthma, specifically maternal asthma.
目的:支气管哮喘是儿童中一种重要的慢性疾病,可导致儿童缺勤、住院、家庭经济和心理压力。在世界范围内,哮喘患病率呈上升趋势。关于印度中部儿童支气管哮喘患病率的信息缺乏。因此,这项以社区为基础的研究旨在估计6至14岁儿童哮喘的患病率,并确定相关的危险因素。材料和方法:本横断面研究使用修订的儿童哮喘和过敏国际研究问卷,在印度恰蒂斯加尔邦赖布尔市区进行。采用多阶段随机抽样的方法,选取年龄在6 ~ 14岁的175名儿童作为计算研究样本。结果:175名参与者(88名男性,87名女性)中,13.14%(23名)的参与者在过去的任何时间有喘息,5.14%的参与者在过去1年内有喘息(哮喘患病率)。6 ~ 9岁患病率略高(5.9%)。男孩的患病率(5.6%)高于女孩(4.6%)。然而,在10-14岁年龄组中,更多的女孩受到影响(5.4%对3.7%)。P值有统计学意义的主要危险因素为变应性鼻炎(66.6%)(相对危险度(RR) = 6.9)、支气管哮喘家族史(66%)(RR = 4.6)、母亲哮喘(33.3%)(RR = 6.9)、上层社会经济阶层(55.5%)(RR = 2.9%)。重要的诱发因素是吸入物、寒冷暴露、运动、刺激物和感染。结论:儿童哮喘患病率为5.14%。变应性鼻炎和哮喘家族史,特别是母亲哮喘是显著的危险因素。
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引用次数: 5
A cross-sectional study of skin prick test to Aspergillus fumigatus antigen in asthmatic patients seen at a tertiary healthcare center 某三级医疗中心哮喘患者烟曲霉抗原皮肤点刺试验的横断面研究
Pub Date : 2019-01-01 DOI: 10.4103/ijaai.ijaai_31_18
J. Savio, P. Ramachandran, Vinutha Jairaj, U. Devaraj, G. D'Souza
INTRODUCTION: Asthma is a significant public health problem. The severity of asthma varies from patient to patient and the reasons for this are not fully understood. Atopy is known to play an important part in the pathogenesis of asthma. Sensitization to aeroallergens like house dust mite, animal dander from pets and environmental fungi are evaluated in asthmatics. Severe asthma seems to be associated to environmental fungi with sensitization especially to Aspergillus species. AIMS AND OBJECTIVE: The study aimed at determining the prevalence of Cutaneous Sensitization to Aspergillus species by Skin Prick Test (SPT) in moderate- severe asthmatics. MATERIAL AND METHODS: This study was done on 205 clinically diagnosed asthmatic patients, between September 2012 and August 2013. SPT and spirometry was done in all subjects along with a detailed history. RESULTS: The prevalence rate of Aspergillus sensitized patients is 59.5%. Observations of this study also suggest that the severity of asthma is more in Aspergillus sensitized patients when compared to non-sensitized patients and the duration of asthma was more in Non sensitized. There was no significant association between AEC, total IgE levels and Aspergillus species culture positivity in Aspergillus sensitized patients. Aspergillus terreus was the predominant fungal isolate from both SPT positive and negative patient. There was no significant correlation of fungal culture with SPT. CONCLUSIONS: High levels of Aspergillus sensitization is seen in south Indian subjects and is associated with greater severity and shorter duration of asthma.
简介:哮喘是一个重大的公共卫生问题。哮喘的严重程度因患者而异,其原因尚不完全清楚。已知特应性在哮喘发病机制中起重要作用。哮喘患者对空气过敏原如室内尘螨、宠物动物皮屑和环境真菌的致敏性进行了评估。严重哮喘似乎与环境真菌致敏有关,尤其是对曲霉菌。目的和目的:本研究旨在通过皮肤点刺试验(SPT)确定中重度哮喘患者对曲霉类皮肤致敏的患病率。材料与方法:本研究于2012年9月至2013年8月期间对205例临床诊断为哮喘的患者进行了研究。对所有受试者进行SPT和肺活量测定,并详细记录病史。结果:曲霉致敏患者患病率为59.5%。本研究的观察结果还表明,与未致敏的患者相比,曲霉致敏的患者哮喘的严重程度更高,未致敏的患者哮喘的持续时间更长。曲霉致敏患者的AEC、总IgE水平与曲霉种培养阳性无显著相关性。SPT阳性和阴性患者均以土曲霉为主。真菌培养与SPT无显著相关。结论:在南印度受试者中可见高水平的曲霉致敏,并且与哮喘的严重程度和持续时间较短相关。
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引用次数: 7
期刊
Indian Journal of Allergy Asthma and Immunology
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