高强度间歇训练对哮喘患者吸入糖皮质激素剂量的影响：一项随机对照试验
2023/06/25
摘要
背景：吸入性皮质类固醇（ICS）是哮喘治疗的基石。但ICS有副作用，建议尽可能减少剂量。体育锻炼可以改善哮喘的控制，但是否可以减少对ICS的依赖尚不清楚。
目的：评估有监督的高强度间歇训练是否可以减少未经训练的哮喘患者对ICS的需求。
方法：一项评估者盲法单中心随机对照试验，丹麦哥本哈根。150名未经训练的ICS治疗的有症状哮喘成人被随机分配（2:1）至6个月的监督锻炼，每周3次或按常规生活方式对照组。每两个月，两组均应用基于症状控制的临床算法来调整ICS剂量。主要结果是6个月后ICS剂量减少25%或更多的比例。次要结果包括以微克/天为单位的实际ICS剂量。
结果：2017年10月至2019年12月，102名患者被分配到运动干预（完成86%），48名患者被分配到对照组（完成85%）。在6个月的随访中，运动组和对照组分别有63%和50%达到了主要结果（调整后的风险差异为9.6%[95%CI-3.8-18.8]；P=0.15）。每日ICS剂量减少，有利于运动组，平均差异为-234μg（95%CI-391-77；P=0.0037），相当于比基线减少24%。这种影响持续了12个月。干预是安全的，耐受性良好。
结论：六个月的定期运动可以减少每日ICS剂量，而不会影响哮喘控制。
Effect of High-Intensity Interval Training on Inhaled Corticosteroid Dose in Asthma Patients: A Randomized Controlled Trial
Anders Pitzner-Fabricius, Christian H Dall, Marius Henriksen, Erik S H Hansen, Louise L Toennesen, Morten Hostrup, Vibeke Backer
Abstract
Background: Inhaled corticosteroids (ICS) are the cornerstone of asthma treatment. However, ICS has side effects, and dose reduction is recommended when possible. Physical exercise improves asthma control, but it is unknown whether it reduces the reliance on ICS.
Objective: To assess whether supervised high-intensity interval training reduces the need for ICS in untrained asthma patients.
Methods: An assessor-blinded single-center randomized controlled trial, Copenhagen, Denmark. One hundred fifty untrained ICS-treated adults with symptomatic asthma were randomly assigned (2:1) to 6 months of supervised exercise 3 times weekly or a lifestyle as usual control group. Every second month, a clinical algorithm based on symptom control was applied in both groups to adjust ICS dose. Primary outcome was the proportion who had their ICS dose reduced by 25% or more after 6 months. Secondary outcomes included actual ICS dosage in micrograms per day.
Results: Between October 2017 and December 2019, 102 patients were allocated to exercise intervention (86% completed) and 48 to the control (85% completed). At the 6-month visit, 63% versus 50% met the primary outcome in the exercise and control groups, respectively (adjusted risk difference 9.6% [95% CI -3.8 to 18.8]; P = .15). Daily ICS dose was reduced in favor of the exercise group, with a mean difference of -234 μg (95% CI -391 to -77; P = .0037), corresponding to a 24% reduction from baseline. This effect was sustained at 12 months. The intervention was safe and well tolerated.
Conclusions: Six months of regular exercise results in reduction in daily ICS dose without compromising asthma control.
背景：吸入性皮质类固醇（ICS）是哮喘治疗的基石。但ICS有副作用，建议尽可能减少剂量。体育锻炼可以改善哮喘的控制，但是否可以减少对ICS的依赖尚不清楚。
目的：评估有监督的高强度间歇训练是否可以减少未经训练的哮喘患者对ICS的需求。
方法：一项评估者盲法单中心随机对照试验，丹麦哥本哈根。150名未经训练的ICS治疗的有症状哮喘成人被随机分配（2:1）至6个月的监督锻炼，每周3次或按常规生活方式对照组。每两个月，两组均应用基于症状控制的临床算法来调整ICS剂量。主要结果是6个月后ICS剂量减少25%或更多的比例。次要结果包括以微克/天为单位的实际ICS剂量。
结果：2017年10月至2019年12月，102名患者被分配到运动干预（完成86%），48名患者被分配到对照组（完成85%）。在6个月的随访中，运动组和对照组分别有63%和50%达到了主要结果（调整后的风险差异为9.6%[95%CI-3.8-18.8]；P=0.15）。每日ICS剂量减少，有利于运动组，平均差异为-234μg（95%CI-391-77；P=0.0037），相当于比基线减少24%。这种影响持续了12个月。干预是安全的，耐受性良好。
结论：六个月的定期运动可以减少每日ICS剂量，而不会影响哮喘控制。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2023 May 12;S2213-2198(23)00425-7. doi: 10.1016/j.jaip.2023.04.013.)
(J Allergy Clin Immunol Pract. 2023 May 12;S2213-2198(23)00425-7. doi: 10.1016/j.jaip.2023.04.013.)
Effect of High-Intensity Interval Training on Inhaled Corticosteroid Dose in Asthma Patients: A Randomized Controlled Trial
Anders Pitzner-Fabricius, Christian H Dall, Marius Henriksen, Erik S H Hansen, Louise L Toennesen, Morten Hostrup, Vibeke Backer
Abstract
Background: Inhaled corticosteroids (ICS) are the cornerstone of asthma treatment. However, ICS has side effects, and dose reduction is recommended when possible. Physical exercise improves asthma control, but it is unknown whether it reduces the reliance on ICS.
Objective: To assess whether supervised high-intensity interval training reduces the need for ICS in untrained asthma patients.
Methods: An assessor-blinded single-center randomized controlled trial, Copenhagen, Denmark. One hundred fifty untrained ICS-treated adults with symptomatic asthma were randomly assigned (2:1) to 6 months of supervised exercise 3 times weekly or a lifestyle as usual control group. Every second month, a clinical algorithm based on symptom control was applied in both groups to adjust ICS dose. Primary outcome was the proportion who had their ICS dose reduced by 25% or more after 6 months. Secondary outcomes included actual ICS dosage in micrograms per day.
Results: Between October 2017 and December 2019, 102 patients were allocated to exercise intervention (86% completed) and 48 to the control (85% completed). At the 6-month visit, 63% versus 50% met the primary outcome in the exercise and control groups, respectively (adjusted risk difference 9.6% [95% CI -3.8 to 18.8]; P = .15). Daily ICS dose was reduced in favor of the exercise group, with a mean difference of -234 μg (95% CI -391 to -77; P = .0037), corresponding to a 24% reduction from baseline. This effect was sustained at 12 months. The intervention was safe and well tolerated.
Conclusions: Six months of regular exercise results in reduction in daily ICS dose without compromising asthma control.
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地塞米松治疗嗜酸性哮喘（EXHALE）的安全性和有效性：一项随机对照试验
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经支气管热成形术治疗成人哮喘急性发作的减少
