哮喘联盟

    以往研究证实，吸入环索奈德能够改善患者的肺功能的气道高反应性。为了评价环索奈德能否特异性地改善哮喘患者的小气道功能，Cohen等对平均年龄39岁的轻到中度哮喘患者（FEV1%预计值89%（范围62%～120%））进行了一项随机研究。 
    研究者对16例哮喘患者（7男）分别给予为期5周的安慰剂或环索奈德（320mg，每天1次）治疗，并对以下小气道功能参数进行评估：FEF25-75%、PC20AMP和PC20MCh时FVC下降率（%）、MCh激发后呼气量(CT扫描测定)、单次呼吸氮气闭合气量和肺泡呼出气一氧化氮(eNO)等。结果7例患者接受安慰剂治疗，9例接受环索奈德治疗。治疗结束后，接受环索奈德治疗患者的MCh激发后呼气量和肺泡eNO较治疗前明显增加，分别为59 mL (1569 - 117)和4.4 ppb (1.4 - 54.8)；而安慰剂治疗组二者却较治疗前有所下降，分别为-121 mL (20 to -236)和 -0.4 ppb (7.3 to -3.4) ，两组比较有统计学意义(p<0.05)。但对其他小气道功能指标，环索奈德治疗未有显著改变。 
    鉴于eNO和MCh激发后呼气量分别反映了的小气道炎症和开放程度，因而本研究证实环索奈德能够在小气道内发挥抗炎作用。 

                      (韩伟 青岛大学附属青岛市立医院东院呼吸科266071 摘译)  
                            （Eur. Respir. J., Jun 2008; 31: 1213 - 1220.) 

Ciclesonide improves measures of small airway involvement in asthma. 
Cohen J, Rob Douma W, Ten Hacken NH, Vonk JM, Oudkerk M, Postma DS. 

Ciclesonide is delivered as a small-particle inhaled corticosteroid and improves lung function and airway hyperresponsiveness.To assess whether ciclesonide can specifically improve small airway function in asthma.Sixteen mild-to-moderate asthma patients (7 males, median age 39 (range 19-56) years, FEV1%predicted 89% (range 62-120)) were randomized to 5-week treatment with placebo or 320 microg ciclesonide once daily. The following small airway parameters were assessed: FEF25-75%, percentage fall in FVC at PC20adenosine-’5-monophosphate (AMP) and at PC20methacholine (MCh), expiratory lung volume after MCh challenge on Computed Tomography (CT) scan, Single Breath N2 closing volume, and alveolar exhaled Nitric Oxide (eNO).Seven subjects received placebo, nine ciclesonide.  
Both CT measurements of expiratory lung volume after MCh challenge and alveolar eNO decreased significantly more with ciclesonide, median (range) 4.4 ppb (1.4-54.8) and 59 mL (1569 to -117) respectively, than with placebo, -0.4 ppb (7.3 to -3.4) and -121 mL (20 to -236) respectively. Ciclesonide did not significantly improve other small airways parameters.Inflammation and patency of small airways, reflected by alveolar eNO and air trapping on CT scan, both improve with ciclesonide even in this small number of patients. This indicates that ciclesonide exerts anti-inflammatory effects on small airways.