鼻内给予皮质类固醇对伴有轻度哮喘的过敏性鼻炎患者哮喘控制和生活质量的影响
2010/12/31
背景：鼻炎对哮喘影响的具体机制目前尚未完全清楚。本文研究经鼻腔治疗对哮喘控制和呼吸相关生活质量(HRQoL) 的影响是否由上、下气道炎症变化所介导。
方法：伴有轻度哮喘的过敏性鼻炎患者随机分为治疗组和安慰剂组，治疗为期14天。治疗组患者接受鼻腔给予100 μg 布地奈德，每侧鼻孔一揿，每日两次。治疗前后进行临床、功能及生物学评价。
结果：20名患者入选本研究（男/女: 10/10; 年龄: 31 ± 15岁），最后有17名患者完成该研究。肺功能处于正常范围。总哮喘控制检测（ACT）评分为20 ± 5.3，RHINASTHMA 全球摘要(GS)评分为44 ± 15。鼻腔灌洗液嗜酸性粒细胞比例为9.9%，而且与反应外周气道功能的肺活量参数显著相关（FEF(50): r = 0.48,P=0.03; FEF(25): r=0.47, P=0.03）。呼出气冷凝液(EBC)的pH值为7.33 ± 0.4。经鼻治疗后，嗜酸性粒细胞百分比显著下降(P=0.002)，嗜酸性粒细胞的百分比变化与ACT评分（r = 0.76, P=0.04）和RHINASTHMA GS 评分（r = 0.77, P=0.02）变化相关。EBC pH值的增加与ACT评分和RHINASTHMA GS评分变化无关。
结论：这些结果显示，伴有轻度哮喘的过敏性患者，鼻腔炎症影响哮喘控制和HRQoL。通过鼻腔给予皮质类固醇，使呼吸症状获得控制，这可能由外周气道功能性变化所介导。
（苏楠 审校）
J Asthma. 2010 Nov 4. [Epub ahead of print]
The Effect of Intranasal Corticosteroids on Asthma Control and Quality of Life in Allergic Rhinitis with Mild Asthma.
Scichilone N, Arrigo R, Paternò A, Santagata R, Impellitteri S, Braido F, Baiardini I, Battaglia S, Walter Canonica G, Bellia V.
Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, "Villa Sofia-Cervello" Hospital, Palermo, Italy.
Abstract
Background. The mechanisms through which rhinitis affects asthma have not been completely elucidated. We explored whether the effect of nasal treatment on asthma control and respiratory-related quality of life (HRQoL) is mediated by inflammatory changes of the upper and lower airways.
Methods. Allergic rhinitics with mild asthma were randomized to a 14-day treatment period with either nasal budesonide 100 μg, 1 puff per nostril twice a day, or placebo. Clinical, functional, and biological evaluations were performed before and after treatment. Results. Twenty subjects (M/F: 10/10; age: 31 ± 15 years; mean ± SD) were enrolled, and a total of 17 individuals completely participated in the study. Lung function was within the normal range. The total asthma control test (ACT) score was 20 ± 5.3 and the RHINASTHMA Global Summary (GS) was 44 ± 15. The percentage proportion of eosinophils in nasal lavage was 9.9% and significantly correlated with spirometric parameters reflecting peripheral airway function (for FEF(50): r = 0.48, p = .03; for FEF(25): r = 0.47, p = .03). The pH of the exhaled breath condensate (EBC) was 7.33 ± 0.4. After nasal treatment, the percentage proportion of eosinophils fell significantly (p = .002), and changes in percentage proportion of eosinophils were associated with changes both in the ACT score (r = 0.76, p = .04) and in the RHINASTHMA GS (r = 0.77, p = .02). The increase in the pH of the EBC was not associated with changes in the ACT score or with the RHINASTHMA GS.
Conclusions. These findings confirm that, in subjects with allergic rhinitis with mild asthma, nasal inflammation impacts on asthma control and HRQoL. The improved control of respiratory symptoms obtained with nasal corticosteroids seems to be mediated by functional changes in the peripheral airways.
J Asthma. 2010 Nov 4. [Epub ahead of print]
方法：伴有轻度哮喘的过敏性鼻炎患者随机分为治疗组和安慰剂组，治疗为期14天。治疗组患者接受鼻腔给予100 μg 布地奈德，每侧鼻孔一揿，每日两次。治疗前后进行临床、功能及生物学评价。
结果：20名患者入选本研究（男/女: 10/10; 年龄: 31 ± 15岁），最后有17名患者完成该研究。肺功能处于正常范围。总哮喘控制检测（ACT）评分为20 ± 5.3，RHINASTHMA 全球摘要(GS)评分为44 ± 15。鼻腔灌洗液嗜酸性粒细胞比例为9.9%，而且与反应外周气道功能的肺活量参数显著相关（FEF(50): r = 0.48,P=0.03; FEF(25): r=0.47, P=0.03）。呼出气冷凝液(EBC)的pH值为7.33 ± 0.4。经鼻治疗后，嗜酸性粒细胞百分比显著下降(P=0.002)，嗜酸性粒细胞的百分比变化与ACT评分（r = 0.76, P=0.04）和RHINASTHMA GS 评分（r = 0.77, P=0.02）变化相关。EBC pH值的增加与ACT评分和RHINASTHMA GS评分变化无关。
结论：这些结果显示，伴有轻度哮喘的过敏性患者，鼻腔炎症影响哮喘控制和HRQoL。通过鼻腔给予皮质类固醇，使呼吸症状获得控制，这可能由外周气道功能性变化所介导。
（苏楠 审校）
J Asthma. 2010 Nov 4. [Epub ahead of print]
The Effect of Intranasal Corticosteroids on Asthma Control and Quality of Life in Allergic Rhinitis with Mild Asthma.
Scichilone N, Arrigo R, Paternò A, Santagata R, Impellitteri S, Braido F, Baiardini I, Battaglia S, Walter Canonica G, Bellia V.
Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, "Villa Sofia-Cervello" Hospital, Palermo, Italy.
Abstract
Background. The mechanisms through which rhinitis affects asthma have not been completely elucidated. We explored whether the effect of nasal treatment on asthma control and respiratory-related quality of life (HRQoL) is mediated by inflammatory changes of the upper and lower airways.
Methods. Allergic rhinitics with mild asthma were randomized to a 14-day treatment period with either nasal budesonide 100 μg, 1 puff per nostril twice a day, or placebo. Clinical, functional, and biological evaluations were performed before and after treatment. Results. Twenty subjects (M/F: 10/10; age: 31 ± 15 years; mean ± SD) were enrolled, and a total of 17 individuals completely participated in the study. Lung function was within the normal range. The total asthma control test (ACT) score was 20 ± 5.3 and the RHINASTHMA Global Summary (GS) was 44 ± 15. The percentage proportion of eosinophils in nasal lavage was 9.9% and significantly correlated with spirometric parameters reflecting peripheral airway function (for FEF(50): r = 0.48, p = .03; for FEF(25): r = 0.47, p = .03). The pH of the exhaled breath condensate (EBC) was 7.33 ± 0.4. After nasal treatment, the percentage proportion of eosinophils fell significantly (p = .002), and changes in percentage proportion of eosinophils were associated with changes both in the ACT score (r = 0.76, p = .04) and in the RHINASTHMA GS (r = 0.77, p = .02). The increase in the pH of the EBC was not associated with changes in the ACT score or with the RHINASTHMA GS.
Conclusions. These findings confirm that, in subjects with allergic rhinitis with mild asthma, nasal inflammation impacts on asthma control and HRQoL. The improved control of respiratory symptoms obtained with nasal corticosteroids seems to be mediated by functional changes in the peripheral airways.
J Asthma. 2010 Nov 4. [Epub ahead of print]
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