使用吸入激素治疗肺功能正常而症状上提示哮喘的患者
2009/03/10
关键词：气道炎症；哮喘症状； 诱导痰；糠酸莫米松；安慰剂
在临床上经常遇到一些肺功能正常而症状提示哮喘的患者，对于他们的治疗是否使用激素存在争议。为了回答这一问题，Rytilä等对144例这样患者进行了为期8周的随机、双盲、安慰剂对照研究。研究中治疗组使用糠酸莫米松（mometasone furoate，MF)，400 µg，每天1次。主要疗效指标每周清晨和夜间症状评分变化的平均值，包括：咳嗽、痰量、喘息、气短、胸闷和运动诱发的咳嗽/喘息。在第4周和第8周计算症状总分。
研究发现，与安慰剂比较，MF明显改善清晨症状评分，但夜间症状评分变化在不同治疗组间没有差异。MF改善所有患者的症状评分，尽管其中一些变化在不同治疗组间没有统计学差异。与安慰剂比较，MF提高患者的清晨和夜间PEFR。MF减少诱导痰中嗜酸粒细胞数量和嗜酸粒细胞阳离子蛋白。
根据研究结果，作者认为每天1次MF治疗对于部分肺功能正常而症状提示哮喘的患者有一定治疗作用，可以短期试用吸入激素治疗。对于有治疗反应的患者，需要进一步的研究以明确诊断。
（韩伟 青岛大学医学院附属青岛市市立医院呼吸科 266071 摘译）
（Eur Respir J 2008; 32:989-996）
Eur Respir J 2008; 32:989-996
Treatment with inhaled steroids in patients with symptoms suggestive of asthma but with normal lung function
P. Rytilä, L. Ghaly, S. Varghese,
Keywords: Airway inflammation, asthma symptoms, induced sputum, mometasone furoate, placebo
A total of 144 patients with lower airway symptoms suggestive of asthma, but who did not fulfil the functional criteria of asthma, were included in a randomised, double-blind, placebo-controlled 8-week "proof-of-concept" study with mometasone furoate (MF), 400 µg once daily. The primary efficacy variable was the mean change from baseline in six morning and evening weekly symptom scores: cough, sputum production, wheeze, shortness of breath, chest tightness and exercise-induced cough/wheeze. Total symptom scores were calculated after treatment for 4 and 8 weeks.
Compared with placebo, MF improved total morning symptom score at 8 weeks. Changes in total evening symptom scores did not differ between treatments. MF improved all individual symptom scores more than placebo, although the differences in changes between treatments were not always statistically significant. Morning and evening peak expiratory flow rates increased with MF compared with placebo. MF reduced eosinophils and the levels of eosinophilic cationic protein in induced sputum.
The results show that symptoms suggestive of asthma exist in patients without significant β2-agonist reversibility or diurnal variability in peak flow. Once-daily MF may benefit some of these patients and a short course with inhaled corticosteroids may be tried. Responders should be better identified in further studies.
上一篇：
TNF-α阻滞剂治疗重症持续期哮喘患者的随机、双盲、安慰剂对照研究
下一篇：
长效β激动剂治疗COPD安全有效－推荐LABA与吸入激素联合治疗COPD
