通过高渗组胺咳嗽激发试验评价哮喘患者对糖皮质激素吸入治疗的反应
2010/08/11
背景与目的：支气管激发试验常用于检测糖皮质激素治疗的有效性。不幸的是，在进行肺功能检测时需要患者很好的配合。这些检查时出现的咳嗽与支气管收缩程度有关，而且是自主出现，不依赖于患者是否配合检查。本试验旨在评价高渗组胺溶液激发咳嗽在评价哮喘患者对糖皮质激素吸入治疗的疗效中的作用。
方法：共计16名未接受过糖皮质激素治疗的哮喘患者和10名非哮喘患者入选本研究。患者每天吸入800 mg倍氯米松干粉，持续8周，以控制哮喘症状。治疗前后对吸入高渗组胺溶液所激发的咳嗽进行录像观察。两次激发咳嗽之前完成症状问卷调查。通过计算累计咳嗽次数与最终组胺浓度的比值（CCR）以及记录导致FEV1下降20％时的组胺浓度（PC20），评价气道对高渗组胺溶液的反应性。
结果：哮喘患者的CCR（几何平均数；95％CI）从494（209-1168）次/mg/ml下降至73.6 (29.8-182)次/mg/ml（P = 0.002）。其PC20在治疗期间为1.31（1.07-1.60）mg/mL和1.91（1.33-2.74）mg/mL（P = 0.01）。哮喘患者的症状发生频率显著下降（P = 0.039）。对于非哮喘患者，其PC20、CCR和症状频率未见显著变化。
结论：高渗组胺溶液激发咳嗽和PC20是评价哮喘治疗疗效的有效检测指标。对于不能完成肺功能检测的患者，咳嗽反应尤为重要。
（陈欣 审校）
Clin Respir J. 2010 Apr;4(2):67-73.
Assessment of inhaled corticosteroid treatment response in asthma using hypertonic histamine challenge-induced cough.
Purokivi M, Koskela H, Koistinen T, Peuhkurinen K, Kontra KM.
Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland. minna.purokivi@kuh.fi
Abstract
BACKGROUND AND AIMS: Bronchial provocation tests may be utilised to monitor the efficacy of the corticosteroid treatment. Unfortunately, these measurements necessitate good patient cooperation during the spirometry. Coughing during such tests is related to the degree of the bronchoconstriction and occurs involuntarily, i.e. independent of patient cooperation. This study aimed to evaluate the utility of a hypertonic histamine challenge-induced cough in assessing the efficacy of inhaled corticosteroid treatment.
METHODS: A total of 16 steroid-naïve asthmatics and 10 non-asthmatic, symptomatic controls received 800-microg beclomethasone (Beclomet Easyhaler(R), Orion Ltd., Orion Pharma, Helsinki, Finland) via powder inhaler per day for 8 weeks. Videoed inhalation challenge with hypertonic histamine solution was performed before and after the treatment. Symptom questionnaire was completed before both challenges. The airway responsiveness to hypertonic histamine was expressed as the cumulative number of coughs divided by the final histamine concentration administered [coughs/concentration ratio (CCR)] and as the provocative concentration of histamine to induce a 20% fall in FEV(1)(PC(20)).
RESULTS: CCR [geometric mean; 95% confidence interval (CI)] of the asthmatic subjects decreased from 494 (209-1168) to 73.6 (29.8-182) coughs per mg/mL (P = 0.002). Their PC(20) levels were 1.31 (1.07-1.60) and 1.91 (1.33-2.74) mg/mL over the treatment period (P = 0.01). The symptom frequency also decreased significantly in the asthmatics (P = 0.039). There were no significant changes in PC(20) level, in CCR level or in symptom frequency in non-asthmatic subjects during the treatment.
CONCLUSIONS: Hypertonic histamine challenge-induced cough and PC(20) are sensitive measures in assessing the treatment effect in asthma. The cough response may be especially useful in subjects who cannot perform spirometry reliably.
Clin Respir J. 2010 Apr;4(2):67-73.
方法：共计16名未接受过糖皮质激素治疗的哮喘患者和10名非哮喘患者入选本研究。患者每天吸入800 mg倍氯米松干粉，持续8周，以控制哮喘症状。治疗前后对吸入高渗组胺溶液所激发的咳嗽进行录像观察。两次激发咳嗽之前完成症状问卷调查。通过计算累计咳嗽次数与最终组胺浓度的比值（CCR）以及记录导致FEV1下降20％时的组胺浓度（PC20），评价气道对高渗组胺溶液的反应性。
结果：哮喘患者的CCR（几何平均数；95％CI）从494（209-1168）次/mg/ml下降至73.6 (29.8-182)次/mg/ml（P = 0.002）。其PC20在治疗期间为1.31（1.07-1.60）mg/mL和1.91（1.33-2.74）mg/mL（P = 0.01）。哮喘患者的症状发生频率显著下降（P = 0.039）。对于非哮喘患者，其PC20、CCR和症状频率未见显著变化。
结论：高渗组胺溶液激发咳嗽和PC20是评价哮喘治疗疗效的有效检测指标。对于不能完成肺功能检测的患者，咳嗽反应尤为重要。
（陈欣 审校）
Clin Respir J. 2010 Apr;4(2):67-73.
Assessment of inhaled corticosteroid treatment response in asthma using hypertonic histamine challenge-induced cough.
Purokivi M, Koskela H, Koistinen T, Peuhkurinen K, Kontra KM.
Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland. minna.purokivi@kuh.fi
Abstract
BACKGROUND AND AIMS: Bronchial provocation tests may be utilised to monitor the efficacy of the corticosteroid treatment. Unfortunately, these measurements necessitate good patient cooperation during the spirometry. Coughing during such tests is related to the degree of the bronchoconstriction and occurs involuntarily, i.e. independent of patient cooperation. This study aimed to evaluate the utility of a hypertonic histamine challenge-induced cough in assessing the efficacy of inhaled corticosteroid treatment.
METHODS: A total of 16 steroid-naïve asthmatics and 10 non-asthmatic, symptomatic controls received 800-microg beclomethasone (Beclomet Easyhaler(R), Orion Ltd., Orion Pharma, Helsinki, Finland) via powder inhaler per day for 8 weeks. Videoed inhalation challenge with hypertonic histamine solution was performed before and after the treatment. Symptom questionnaire was completed before both challenges. The airway responsiveness to hypertonic histamine was expressed as the cumulative number of coughs divided by the final histamine concentration administered [coughs/concentration ratio (CCR)] and as the provocative concentration of histamine to induce a 20% fall in FEV(1)(PC(20)).
RESULTS: CCR [geometric mean; 95% confidence interval (CI)] of the asthmatic subjects decreased from 494 (209-1168) to 73.6 (29.8-182) coughs per mg/mL (P = 0.002). Their PC(20) levels were 1.31 (1.07-1.60) and 1.91 (1.33-2.74) mg/mL over the treatment period (P = 0.01). The symptom frequency also decreased significantly in the asthmatics (P = 0.039). There were no significant changes in PC(20) level, in CCR level or in symptom frequency in non-asthmatic subjects during the treatment.
CONCLUSIONS: Hypertonic histamine challenge-induced cough and PC(20) are sensitive measures in assessing the treatment effect in asthma. The cough response may be especially useful in subjects who cannot perform spirometry reliably.
Clin Respir J. 2010 Apr;4(2):67-73.
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