在控制良好的哮喘患者上使用沙美特罗/丙酸氟替卡松联合疗法进行降阶梯治疗
2016/05/31
摘要
目的：吸入糖皮质激素（ICS）和长效β激动剂（LABA）的联合治疗是哮喘患者的标准治疗方法，哮喘控制后推荐降阶梯治疗。然而，很少有资料评估降阶梯治疗后的长期效果。
目标：对此前使用ICS (250 µg 丙酸氟替卡松)/LABA (50 µg 沙美特罗) 联合用药 (SFC, two puffs per day)得到良好控制的哮喘患者，进行ICS/LABA或单独使用ICS降阶梯治疗之后的长期效果的比较。
患者及方法：我们随机将40个用SFC (250 µg)治疗得到良好控制的哮喘患者分成两组；一组患者接受降阶梯治疗与低剂量的SFC（100µg，两喷日1次），另一组接受高剂量的丙酸氟替卡松（FP）单独降阶梯治疗（500µg，每日1次）。分别对两组在哮喘控制测试评分、呼吸功能（1秒钟用力呼气容积、肺活量50%时的最大呼气流速 [ % FEF50 ]，和肺活量在25%时的最大呼气流量 [% FEF25] ）和部分呼出一氧化氮的浓度的变化进行长达12个月监测。
结果：SFC和FP组的脱落率没有显著差异。低剂量的SFC治疗可在12个月内维持各项参数的稳定。然而，FP组显示停用沙美特罗后，1秒钟用力呼气量在2个月内可快速下降5%，并且，10个月之后，%FEF50 和%FEF25逐步下降。
结论：这项研究表明，一个平衡的降阶梯治疗方案，包括同时使用ICS和LABA，对有轻度至中度哮喘且良好控制的患者的长期稳定必不可少。
（杨冬 审校）
J Asthma Allergy. 2016 Mar 18;9:65-70. doi: 10.2147/JAA.S93782. eCollection 2016.
Step-down therapy in well-controlled asthmatic patients using salmeterolxinafoate/fluticasone propionate combination therapy.
Horiuchi K1, Kasahara K1, Kuroda Y1, Morohoshi H1, Hagiwara Y1, Ishii G1.
Author information
Abstract
PURPOSE:A combination therapy with inhaled corticosteroid (ICS) and a long-acting β agonist (LABA) is the standard treatment for asthmatic patients, and step-down treatment is recommended once control has been achieved. However, little data exist that evaluate the long-term outcomes after step-down treatment.
OBJECTIVE:To compare the long-term outcomes of step-down therapy with ICS/LABA or ICS alone for asthmatic patients who have achieved well-controlled asthma by the ICS (250 µg fluticasone)/LABA (50 µg salmeterol) combination (SFC, two puffs per day).
PATIENTS AND METHODS:We randomized 40 well-controlled patients with asthma receiving SFC (250 µg) to two groups; one group of patients received step-down therapy with low-dose SFC (100 µg, two puffs daily) and another group of patients received step-down therapy with high-dose fluticasone propionate (FP) alone (500 µg, daily). The two groups were monitored over 12 months for changes in asthma control test scores, respiratory function (percent forced expiratory volume in 1 second, maximal expiratory flow rate at 50% of the vital capacity [%FEF50], and maximal expiratory flow rate at 25% of the vital capacity [%FEF25]), and the concentration of fractional exhaled nitric oxide.
RESULTS:There was no significant difference in the dropout rate between the SFC and FP groups. Low-dose SFC maintained the stability of all parameters over 12 months, whereas the FP group exhibited a rapid 5% decrease in forced expiratory volume in 1 second within 2 months after discontinuation of salmeterol; furthermore, after 10 months, there was a gradual decrease in %FEF50 and %FEF25.
CONCLUSION:This study suggests that a balanced step-down protocol, including both ICS and LABA, is essential in providing long-term stability to patients with mild-to-moderate well-controlled asthma.
KEYWORDS:asthma; fluticasone propionate; long-term outcome; salmeterol; step down
J Asthma Allergy. 2016 Mar 18;9:65-70. doi: 10.2147/JAA.S93782. eCollection 2016.
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慢性阻塞性肺疾病与哮喘患者因切换装置吸入性错误：重要的健康和经济问题
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沙丁胺醇多剂量干粉吸入器在持续性哮喘患者中使用12周和52周的安全性
