伴过敏性鼻炎的轻度哮喘患者，鼻内皮质激素治疗对哮喘控制和生活质量的影响
2011/03/28
摘要
背景：鼻炎对哮喘影响的机制目前尚未完全清楚。本试验研究鼻炎治疗对哮喘控制和呼吸道疾病相关生活质量(HRQoL)的影响是否与上和下呼吸道炎症改变相关。
方法：伴有过敏性鼻炎的轻症哮喘患者随机分为治疗组和安慰剂组。治疗组患者在14天的治疗期中，鼻内使用布地奈德（100 μg/揿/鼻孔，每日2次）。治疗前后进行临床、功能性和生物学评价。
结果：20名研究对象入选（男/女：10/10；年龄：31±15岁），共17名受试者完成本研究。研究对象肺功能正常。总体哮喘控制测试（ACT）评分为20±5.3，RHINASTHMA 全局总结评分（GS）为44±15。鼻腔灌洗液的嗜酸性粒细胞比例为9.9%，而且与肺活量相关参数（FEF50：r=0.48, p=0.03; FEF25: r=0.47, P=0.03）显著相关。呼出气冷凝液的pH值为7.33±0.4。经鼻内激素治疗后，嗜酸性粒细胞比例显著下降(P=0.002)。此外，嗜酸性粒细胞比例的变化与ACT评分变化(r=0.76, P=0.04)和GS评分变化(r=0.77, P=0.02)相关。呼出气冷凝液pH值的增加与ACT评分变化和GS评分变化无关。
结论：这些结果证实，伴有过敏性鼻炎的轻度哮喘患者，鼻部炎症对哮喘控制和HRQoL产生重要影响。鼻部使用皮质激素治疗，能显著控制呼吸道症状，这可能与外周呼吸道功能性变化相关。
（苏楠 审校）
J Asthma. 2011 Feb;48(1):41-47. Epub 2010 Nov 4.
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. 2011 Feb;48(1):41-7. Epub 2010 Nov 4.
背景：鼻炎对哮喘影响的机制目前尚未完全清楚。本试验研究鼻炎治疗对哮喘控制和呼吸道疾病相关生活质量(HRQoL)的影响是否与上和下呼吸道炎症改变相关。
方法：伴有过敏性鼻炎的轻症哮喘患者随机分为治疗组和安慰剂组。治疗组患者在14天的治疗期中，鼻内使用布地奈德（100 μg/揿/鼻孔，每日2次）。治疗前后进行临床、功能性和生物学评价。
结果：20名研究对象入选（男/女：10/10；年龄：31±15岁），共17名受试者完成本研究。研究对象肺功能正常。总体哮喘控制测试（ACT）评分为20±5.3，RHINASTHMA 全局总结评分（GS）为44±15。鼻腔灌洗液的嗜酸性粒细胞比例为9.9%，而且与肺活量相关参数（FEF50：r=0.48, p=0.03; FEF25: r=0.47, P=0.03）显著相关。呼出气冷凝液的pH值为7.33±0.4。经鼻内激素治疗后，嗜酸性粒细胞比例显著下降(P=0.002)。此外，嗜酸性粒细胞比例的变化与ACT评分变化(r=0.76, P=0.04)和GS评分变化(r=0.77, P=0.02)相关。呼出气冷凝液pH值的增加与ACT评分变化和GS评分变化无关。
结论：这些结果证实，伴有过敏性鼻炎的轻度哮喘患者，鼻部炎症对哮喘控制和HRQoL产生重要影响。鼻部使用皮质激素治疗，能显著控制呼吸道症状，这可能与外周呼吸道功能性变化相关。
（苏楠 审校）
J Asthma. 2011 Feb;48(1):41-47. Epub 2010 Nov 4.
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. 2011 Feb;48(1):41-7. Epub 2010 Nov 4.
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糠酸莫米松/富马酸福莫特罗临床试验中哮喘持续期的青少年和成人患者的哮喘控制状态变化评估
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