2015年 · 第38卷第06期

The rapid development of bacterial drug resistance is a serious problem faced by the world, which has attracted the attention of government departments in many countries, and may become one of the topics of the G20 leaders' meeting to be held in China in 2016. In order to solve this problem, it is of course one of the necessary choices to develop effective drugs with a new mechanism. However, because the research and development of new anti-infective drugs is becoming more and more difficult and expensive, many manufacturers are discouraged, resulting in the birth speed of new drugs lagging far behind the development of drug resistance. On the other hand, we have more than 100 anti-infective drugs successfully marketed for clinical selection. How to give full play to the role and potential of existing anti-infective drugs is also an indispensable and effective means to solve the above problems, such as scientifically changing conventional drug administration methods and necessary off-label applications according to the pharmacodynamic and pharmacokinetic (PK/PD) properties of drugs.

Pulmonary function examination is the main component of respiratory physiology examination. Through the use of respiratory physiology knowledge and modern examination technology, it can dynamically understand and explore the state of human respiratory function. In contrast, well-known examinations such as chest X-rays, CT scans, and respiratory histopathology reflect static histological changes.

The diagnosis of pulmonary function mainly includes the judgment of normal values of pulmonary function parameters and the evaluation of pulmonary ventilation and ventilation function. There are many contents in both aspects that have not yet reached consensus or are difficult to reach consensus, and there are many controversies, among which the reasonable evaluation of parameters is the core of handling the controversy.

Pulmonary function tests in China began in the 1930s, were carried out one after another after the 1950s, began to rise in the late 1970s, and developed rapidly after the 1990s. In recent 20 years, with the continuous updating of pulmonary function testing instruments, the continuous improvement of technology and the wider application range, the clinical research and epidemiological investigation related to pulmonary function are increasing day by day, and some researches have achieved remarkable results. However, at present, there are still many problems in the clinical application and quality of lung function in China, such as the application has not been fully popularized, the operation is lack of standardization, and the quality control is not strict, which affects the guiding role of lung function test in the diagnosis and treatment of respiratory diseases. The author believes that the root of the problem lies in the lack of attention to lung function training in many hospitals. On the one hand, lung function test technicians lack standardized training on lung function test techniques; On the other hand, clinicians, especially respiratory specialists, lack training in the clinical application of pulmonary function tests.

Drug instructions are the most important basis for clinicians to prescribe. However, due to the continuous discovery and experience accumulation of drugs in clinical application, coupled with the long clinical registration trial cycle of drugs and the relatively lagging update of drug instructions, the use of drugs beyond the instructions has its scientific nature and rationality, which is often inevitable in clinical practice, and sometimes even becomes the only means to save lives. Compared with other classes of drugs, antimicrobial drugs are more prevalent and commonly used over-indication for sensitive bacteria or over-dose for less-sensitive bacteria. According to literature reports, among more than 720 million prescriptions in 25 studies, prescriptions for off-label use of antibacterial drugs in adult critically ill patients accounted for 19% ~43%, and general outpatient clinics also accounted for 23%@^[1]。 It can be seen that the off-label use of antibacterial drugs is a common phenomenon in clinical practice.

Bronchial asthma (asthma) is one of the common chronic respiratory diseases. Frequent acute attacks and long-term medication can easily lead to psychological and emotional disorders of patients, which in turn can induce and aggravate asthma, resulting in a "vicious circle". Therefore, asthma is regarded as a physical and mental disease. Anxiety is one of the common psychological disorders in asthma, its incidence rate is 20% ~30%. The subjective manifestation is nervous, unpleasant, and even painful so that it is difficult to control itself. In severe cases, it is accompanied by autonomic nerve dysfunction^[1]。 However, the research on giving anti-anxiety therapy to asthmatic patients with anxiety is not sufficient, especially whether anxiety can aggravate airway inflammation in asthmatic patients has not been reported. Therefore, this study intends to construct a model of BALB/c asthmatic mice with anxiety stress, and give escitalopram for anti-anxiety therapy to study whether anti-anxiety therapy can reduce airway hyperresponsiveness and inflammation in asthmatic mice with anxiety.

According to the Montreal Protocol, Chlorofluorocarbon (also known as Chlorofluorocarbon, CFC), the driver in aerosols, will be completely banned and eventually replaced by Hydrofluoroalkane (HFA). CFC has a strong ozone layer destroying effect^[1], elimination is necessary, China has determined that the final elimination date of CFC – MDI is December 31, 2017^[2]。 As clinical pharmacists, physicians often ask us about whether there is any change in the efficacy of HFA after replacing CFC. Because by comparing the 2010, 2012, and 2014 GINA^[3,4,5]They were surprised to find that among the commonly used clinical inhaled corticosteroids (ICS), the dose of HFA-driven beclomethasone (BDP) is about half that of CFC-driven, while other commonly used ICS do not have this difference, such as budesonide (BUD) and fluticasone (FP), seeTable 1。 Bronchodilators such as salbutamol (SAL) are also indistinguishable.

This part is the continuation of the first part "Interpretation of lung volume parameters"^[1]。

In clinical work, we often encounter patients with intrapulmonary space occupation combined with hilar and/or mediastinal lymphadenopathy, and simple hilar and/or mediastinal lymphadenopathy. In this case, the diagnosis cannot be confirmed by chest CT alone, because many diseases can have similar imaging manifestations, such as lung cancer, metastatic tumor, lymphoma, sarcoidosis and lymph node tuberculosis. Bronchoscopic mucosal biopsy or brush examination can confirm some patients with microscopic new organisms or mucosal infiltration, but for patients with no new organisms and normal bronchial mucosal manifestations under bronchoscopy, routine bronchoscopy is difficult to confirm the diagnosis. This condition often requires relying on TBNA, EBUS-TBNA or mediastinoscopy to be definitively diagnosed^[1]。 Mediastinoscopy is still the "gold standard" of mediastinal lymph node biopsy at present^[2]However, mediastinoscopy cannot be routinely performed in many places, and it requires hospitalization under general anesthesia. It is expensive and traumatic, with complications and mortality rates ranging from 1.4% to 2.3%. At present, mediastinoscopy is often considered when the TBNA or EBUS-TBNA results are negative^[3]。 Due to economic factors and the learning curve of new technologies, there are few hospitals in China to perform EBUS-TBNA, so TBNA remains the preferred method to determine the nature of mediastinal or hilar enlarged lymph nodes in most hospitals^[1]。

The second event of Beijing Young Respiratory Scholars Salon in 2015 was held on March 26th, 2015. This event was hosted by Dr. Bu Xiaoning, Beijing Chaoyang Hospital affiliated to Capital Medical University. The theme was "Correct understanding of the recommendations from international/domestic guidelines for pulmonary embolism". The meeting format was case sharing and discussion.

"Expert Consensus on Atomization Therapy (Draft)" formulated by the Respiratory Therapy Group of Respiratory Disease Branch of Chinese Medical Association^[1](referred to as "consensus") has played an extremely important role in standardizing the use of nebulization therapy in China. We read the article in detail and do not take the liberty to ask the following questions and opinions to discuss with the author.

Thank you for your questions and suggestions on the "Expert Consensus on Atomization Therapy (Draft)" ("Consensus" for short)! After we read it carefully, the classification answers are as follows.