哮喘急性加重与肺功能的下降
2010/01/07
目的：明确严重哮喘急性发作是否与持续的肺功能降低相关；吸入布地奈德对肺功能降低的潜在作用。
方法：START研究是为期3年、随机双盲研究。研究对象为7165名（5～66岁）持续哮喘至少2年的患者。明确早期低剂量吸入布地奈德是否可预防严重哮喘相关事件（需住院治疗或急诊治疗）及肺功能降低。
结果：315人至少经历1次急性加重。305人数据可分析。对照组190人，布地奈德组115人。对照组中，经历过急性加重和无急性加重患者比较，研究前后支气管舒张剂后FEV1变化值分别为-6.44%，-2.43%（P<0.001）。此差异在儿童与成人中明显，青少年不明显。布地奈德组中，经历过急性加重和无急性加重患者比较，研究前后支气管舒张剂后FEV1变化值分别为-2.48%，-1.72%（P=0.57）；经历过至少1次严重哮喘相关事件者与无此经历者相比，降低幅度差异显著（P=0.042）。
结论：严重哮喘急性发作与更快的肺功能下降有关。低剂量吸入糖皮质激素可减弱肺功能的下降。
（农英 卫生部中日友好医院呼吸内科 100029 摘译）
（Am J Respir Crit Care Med. 2009 Jan 1;179(1):19-24）
Severe exacerbations and decline in lung function in asthma.
O’Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW; START Investigators Group
RATIONALE: To evaluate the association between asthma exacerbations and the decline in lung function, as well as the potential effects of an inhaled corticosteroid, budesonide, on exacerbation-related decline in patients with asthma.
OBJECTIVES: To determine whether severe asthma exacerbations are associated with a persistent decline in lung function.
METHODS: The START (inhaled steroid treatment as regular therapy in early asthma) study was a 3-year, randomized, double-blind study of 7,165 patients (5-66 yr) with persistent asthma for less than 2 years, to determine whether early intervention with low-dose inhaled budesonide prevents severe asthma-related events (exacerbations requiring hospitalization or emergency treatment) and decline in lung function.
MEASUREMENTS AND MAIN RESULTS: There were 315 patients who experienced at least one severe asthma exacerbation, of which 305 were analyzable, 190 in the placebo group and 115 in the budesonide group. In the placebo group, the change in post-bronchodilator FEV(1) % predicted from baseline to the end of the study, in patients who did or did not experience a severe exacerbation was -6.44% and -2.43%, respectively (P < 0.001). A significant difference was seen in both children and in adults, but not in adolescents. In the budesonide group, the change in the post-bronchodilator FEV(1) % predicted in patients who did or did not experience a severe exacerbation was -2.48% and -1.72%, respectively (P = 0.57). The difference in magnitude of reduction afforded by budesonide, in patients who experienced at least one severe asthma-related event compared with those who did not, was statistically significant (P = 0.042).
CONCLUSIONS: Severe asthma exacerbations are associated with a more rapid decline in lung function. Treatment with low doses of inhaled corticosteroid is associated with an attenuation of the decline.
Am J Respir Crit Care Med. 2009 Jan 1;179(1):19-24
方法：START研究是为期3年、随机双盲研究。研究对象为7165名（5～66岁）持续哮喘至少2年的患者。明确早期低剂量吸入布地奈德是否可预防严重哮喘相关事件（需住院治疗或急诊治疗）及肺功能降低。
结果：315人至少经历1次急性加重。305人数据可分析。对照组190人，布地奈德组115人。对照组中，经历过急性加重和无急性加重患者比较，研究前后支气管舒张剂后FEV1变化值分别为-6.44%，-2.43%（P<0.001）。此差异在儿童与成人中明显，青少年不明显。布地奈德组中，经历过急性加重和无急性加重患者比较，研究前后支气管舒张剂后FEV1变化值分别为-2.48%，-1.72%（P=0.57）；经历过至少1次严重哮喘相关事件者与无此经历者相比，降低幅度差异显著（P=0.042）。
结论：严重哮喘急性发作与更快的肺功能下降有关。低剂量吸入糖皮质激素可减弱肺功能的下降。
（农英 卫生部中日友好医院呼吸内科 100029 摘译）
（Am J Respir Crit Care Med. 2009 Jan 1;179(1):19-24）
Severe exacerbations and decline in lung function in asthma.
O’Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW; START Investigators Group
RATIONALE: To evaluate the association between asthma exacerbations and the decline in lung function, as well as the potential effects of an inhaled corticosteroid, budesonide, on exacerbation-related decline in patients with asthma.
OBJECTIVES: To determine whether severe asthma exacerbations are associated with a persistent decline in lung function.
METHODS: The START (inhaled steroid treatment as regular therapy in early asthma) study was a 3-year, randomized, double-blind study of 7,165 patients (5-66 yr) with persistent asthma for less than 2 years, to determine whether early intervention with low-dose inhaled budesonide prevents severe asthma-related events (exacerbations requiring hospitalization or emergency treatment) and decline in lung function.
MEASUREMENTS AND MAIN RESULTS: There were 315 patients who experienced at least one severe asthma exacerbation, of which 305 were analyzable, 190 in the placebo group and 115 in the budesonide group. In the placebo group, the change in post-bronchodilator FEV(1) % predicted from baseline to the end of the study, in patients who did or did not experience a severe exacerbation was -6.44% and -2.43%, respectively (P < 0.001). A significant difference was seen in both children and in adults, but not in adolescents. In the budesonide group, the change in the post-bronchodilator FEV(1) % predicted in patients who did or did not experience a severe exacerbation was -2.48% and -1.72%, respectively (P = 0.57). The difference in magnitude of reduction afforded by budesonide, in patients who experienced at least one severe asthma-related event compared with those who did not, was statistically significant (P = 0.042).
CONCLUSIONS: Severe asthma exacerbations are associated with a more rapid decline in lung function. Treatment with low doses of inhaled corticosteroid is associated with an attenuation of the decline.
Am J Respir Crit Care Med. 2009 Jan 1;179(1):19-24
上一篇：
系列PEF分析对职业性哮喘的诊断优于PEF变异率
下一篇：
呼出NO——吸烟者哮喘控制情况的标志
