低剂量茶碱联合倍氯米松对哮喘吸烟者肺功能的作用
2010/01/07
关键词：哮喘；激素敏感性；组蛋白脱乙酰基酶；吸烟；茶碱
在临床中很多哮喘患者吸烟，而且吸烟与哮喘控制不佳以及激素治疗反映下降有关。那么如何调整吸烟哮喘患者的治疗？Spears等采用小剂量茶碱联合吸入激素治疗这些患者，观察这一方案对患者肺功能和症状的影响。
作者对68例哮喘患者进行了为期4周的双盲、对照研究。研究患者分为3组：吸入激素组（倍氯米松 200 µg·day–1)、茶碱组(茶碱 400 mg·day–1) 和联合治疗组（（倍氯米松 200 µg·day–1+茶碱 400 mg·day–1)）。考察结果包括：肺功能变化，哮喘控制问卷（ACQ）评分。
结果显示，相对于单纯吸入激素，联合治疗能明显改善患者的PEF(39.9 L·min–1, 95% CI: 10.9～68.8) 和ACQ 评分(-0.47, 95% CI -0.91～ -0.04) ，对FEV1也有一定提高（165 mL, 95% CI -13–342)。而单用茶碱虽能改进患者的ACQ评分 (-0.55, 95% CI -0.99– -0.11)，但对肺功能没有作用。
本研究证实小剂量茶碱联合倍氯米松能够改善吸烟哮喘患者的肺功能和症状，但样本量较小，需要更大规模的研究来证实和拓展这一结果。
（韩伟 青岛市市立医院东院呼吸科 266071 摘译）
（Eur Respir J 2009; 33:1010-1017）
Effect of low-dose theophylline plus beclometasone on lung function in smokers with asthma: a pilot study
M. Spears1, I. Donnelly2, L. Jolly2, M. Brannigan1, K. Ito3, C. McSharry2, J. Lafferty1, R. Chaudhuri1, G. Braganza1, I. M. Adcock3, P. J. Barnes3, S. Wood, 
4 and N. C. Thomson1
4 and N. C. Thomson1 Keywords: Asthma, corticosteroid insensitivity, histone deacetylase, smoking, theophylline
Smoking is common in asthma and is associated with worse asthma control and a reduced therapeutic response to corticosteroids. The present authors hypothesised that treating smokers with asthma with low-dose theophylline added to inhaled corticosteroids would enhance steroid sensitivity and thereby improve lung function and symptoms.
In a double-blind, parallel group exploratory trial, 68 asthmatic smokers were randomised to one of three treatments for 4 weeks: inhaled beclometasone (200 µg·day–1), theophylline (400 mg·day–1) or both treatments combined. Outcome measures included change in lung function and Asthma Control Questionnaire (ACQ) scores.
At 4 weeks, theophylline added to inhaled beclometasone produced an improvement in peak expiratory flow (39.9 L·min–1, 95% confidence intervals (CI) 10.9–68.8) and ACQ score (-0.47, 95% CI -0.91– -0.04) and a borderline improvement in pre-bronchodilator forced expiratory volume in one second (mean difference 165 mL, 95% CI -13–342) relative to inhaled corticosteroid alone. Theophylline alone improved the ACQ score (-0.55, 95% CI -0.99– -0.11), but not lung function.
In the present pilot study, the combination of low-dose theophylline and inhaled beclometasone produced improvements in both lung function and symptoms in a group of smokers with asthma. Larger trials are required to extend and confirm these findings.
Eur Respir J 2009; 33:1010-1017
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