哮喘联盟

   摘要
   目的：吸入性和全身性类固醇激素通常用于治疗哮喘患者的气道炎症反应，但是，类固醇激素可导致一系列不良反应，包括骨质疏松症等。本研究旨在评估在埃德蒙顿地区重度哮喘治疗中心的中度至重度哮喘患者骨量减少/骨质疏松的发生率。
   方法：我们采用回顾性病历分析的方法对专科门诊57个中度至重度的哮喘患者的病历进行分析，记录其骨密度（BMD）。评估其类固醇激素的使用情况，并比较长期全身性类固醇激素使用群体（第1组，n=15）、间歇性全身性类固醇激素使用群体（第2组，n=15）以及吸入性类固醇激素使用群体（第3组，n=27）间骨量减少/骨质疏松的发生率差异。
   结果：患者的平均年龄为50±14.8岁（均值±标准差）。第1组患者累积的全身性类固醇激素（强的松龙）使用量显著高于第2组的患者（12.5 mg/天 vs. 3.2 mg/天，p=0.002）。第1组和第2组患者骨量减少/骨质疏松的发生率无显著差异（67% vs. 53%，p=0.46），但是第1组患者骨量减少/骨质疏松的发生率显著高于第3组的患者（67% vs. 33%，p=0.038）。
   结论：中度至重度哮喘患者群体骨密度降低的发生率较高，许多间断应用全身性类固醇激素治疗哮喘急性发作的患者以及长期吸入性类固醇激素治疗的患者通常在50岁以前 发生骨量减少或骨质疏松。国内和国际的骨质疏松症诊疗指南应强调在哮喘患者中进行早期筛查。我们应该提高对短期全身性类固醇激素以及长期吸入性激素使用将导致骨密度下降副作用的意识，对于幼年便开始激素治疗的患者以及生活在北方的患者尤其重要。
 

（杨冬 审校）
Clin Invest Med. 2015 Apr 8;38(1):E23-30.
 

Prevalence of osteopenia and osteoporosis in patients with moderate to severeasthma in Western Canada.
 

Li P1, Ghazala L, Wright E, Beach J, Morrish D, Vethanayagam D.

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Abstract
PURPOSE:Steroids, inhaled and systemic, are used to treat airway inflammation in patients with asthma; however, steroids are recognized to cause a number of side effects, including osteoporosis. We evaluated the prevalence of osteopenia/osteoporosis in patients with moderate-severe asthma managed through the Edmonton Regional Severe Asthma Centre.
METHODS:We performed a retrospective chart review and analyzed 57 charts on patients with moderate-severe asthma followed through the specialty clinic, and recorded their bone mineral density (BMD). Steroid use was reviewed and the frequency of osteopenia/osteoporosis was compared in patients requiring continuous systemic steroids (Group 1, n=15), intermittent systemic steroids (Group 2, n=15) or inhaled steroids only (Group 3, n=27).
RESULTS:The mean age (mean±SD) was 50±14.8 years. Cumulative systemic steroid dose of prednisone equivalent was higher in Group 1 (12.5 mg/day) than Group 2 (3.2 mg/day) (p=0.002). The frequency of osteopenia / osteoporosis was not significantly different between patients in Group 1(67%) and Group 2 (53%, p=0.46) but was significantly greater in patients from Group 1 in comparison with Group 3 (33%, p=0.038).
CONCLUSION:Patients with moderate-severe asthma have a high prevalence of reduced bone density. Many patients treated with intermittent systemic steroids for exacerbations, or who were stable on inhaled steroids, had either osteopenia or osteoporosis before the age of 50. National and international osteoporosis guidelines should emphasize earlier screening for asthma patients; and increase awareness of the detrimental effects of short-term systemic steroids and inhaled steroids on BMD, especially when started at an early age and in northern climates.
 

Clin Invest Med. 2015 Apr 8;38(1):E23-30.